Provider Demographics
NPI:1396341681
Name:COTTO, STEPHANIE J (MSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:COTTO
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:AVE EL JIBARIO CARR 172 KM 13.25 INT
Mailing Address - Street 2:BO BAYAMON
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-739-8182
Mailing Address - Fax:
Practice Address - Street 1:AVE EL JIBARO CARR 172 KM 13.25 INT
Practice Address - Street 2:BO BAYAMON
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-308-2641
Practice Address - Fax:787-714-1444
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR152271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6143689OtherDEIVER LICENSE