1700617677 NPI number — ROCHELLE MEDINA BERRIOS MEDINA LCSW

Table of content: ROCHELLE MEDINA BERRIOS MEDINA LCSW (NPI 1700617677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700617677 NPI number — ROCHELLE MEDINA BERRIOS MEDINA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRIOS MEDINA
Provider First Name:
ROCHELLE
Provider Middle Name:
MEDINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700617677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB LA RAMBLA 1787
Provider Second Line Business Mailing Address:
CALLE SIERVAS DE MARIA
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-298-9797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB LA RAMBLA 1787
Provider Second Line Business Practice Location Address:
CALLE SIERVAS DE MARIA
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-974-2443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  16914 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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