Provider Demographics
NPI:1487963484
Name:DESARDEN VIALIZ, MARIAN (MSW)
Entity type:Individual
Prefix:MISS
First Name:MARIAN
Middle Name:
Last Name:DESARDEN VIALIZ
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:CARRETERA 107 KM 2.3
Mailing Address - Street 2:BARRIO BORINQUEN
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-641-9133
Mailing Address - Fax:
Practice Address - Street 1:CARR107 KM 22.2
Practice Address - Street 2:PLAZA DEL MAR
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4007
Practice Address - Country:US
Practice Address - Phone:787-641-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical