Provider Demographics
NPI:1366312878
Name:SERRANO VELAZQUEZ, MYRTA YAHAIRA (CSW)
Entity type:Individual
Prefix:
First Name:MYRTA
Middle Name:YAHAIRA
Last Name:SERRANO VELAZQUEZ
Suffix:
Gender:F
Credentials:CSW
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 8775
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8775
Mailing Address - Country:US
Mailing Address - Phone:787-689-3985
Mailing Address - Fax:
Practice Address - Street 1:8133 CALLE CONCORDIA
Practice Address - Street 2:SUITE 202
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1543
Practice Address - Country:US
Practice Address - Phone:787-466-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical