Provider Demographics
NPI:1073326583
Name:ACOSTA BLANCO, CARLOS MANUEL (MSW)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:ACOSTA BLANCO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 9 BOX 4186
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9433
Mailing Address - Country:US
Mailing Address - Phone:787-404-2592
Mailing Address - Fax:
Practice Address - Street 1:HC 9 BOX 4186
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-9433
Practice Address - Country:US
Practice Address - Phone:787-404-2592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR137011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical