Provider Demographics
NPI:1194174607
Name:FALCON, SULLY ANE (PHD)
Entity type:Individual
Prefix:
First Name:SULLY
Middle Name:ANE
Last Name:FALCON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 781 KM 2.1
Mailing Address - Street 2:PARCELA #29
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782
Mailing Address - Country:US
Mailing Address - Phone:787-614-9677
Mailing Address - Fax:
Practice Address - Street 1:CALLE 781 KM 2.1
Practice Address - Street 2:PARCELA #29
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782
Practice Address - Country:US
Practice Address - Phone:787-614-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8590104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker