Provider Demographics
NPI:1073356929
Name:CUEVAS DEJESUS, CAROL JOMELY
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JOMELY
Last Name:CUEVAS DEJESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 OLMO CONDOMINIO HIGHLAND PARK
Mailing Address - Street 2:APT. 401
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-914-9167
Mailing Address - Fax:
Practice Address - Street 1:CARR. NO.2 KM.8.2 BO. JUAN SANCHEZ
Practice Address - Street 2:ANTIGUO HOSPITAL MEPSI CENTER
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00969-7087
Practice Address - Country:US
Practice Address - Phone:787-914-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15826104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker