Provider Demographics
NPI:1962263095
Name:CASILLAS CARMONA, ANGEL DAVID SEM (MHS)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:DAVID SEM
Last Name:CASILLAS CARMONA
Suffix:
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CC42 CALLE 14
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-5130
Mailing Address - Country:US
Mailing Address - Phone:787-220-5461
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE HORTENSIA APT 12G
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6416
Practice Address - Country:US
Practice Address - Phone:787-220-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor