Provider Demographics
NPI:1215760418
Name:OCASIO MIRANDA, ANGELY MARIE (MSW)
Entity type:Individual
Prefix:
First Name:ANGELY
Middle Name:MARIE
Last Name:OCASIO MIRANDA
Suffix:
Gender:F
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:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1379
Mailing Address - Country:US
Mailing Address - Phone:787-714-2462
Mailing Address - Fax:
Practice Address - Street 1:CALLE SARGENTO GERARDO SANTIAGO
Practice Address - Street 2:CARR. 14 INT 15
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-714-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR265231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical