Provider Demographics
NPI:1972305704
Name:BERDECIA, LUIS ANTONIO SR
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO
Last Name:BERDECIA
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 CALLE SALUD APT 13
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-5828
Mailing Address - Country:US
Mailing Address - Phone:787-674-7918
Mailing Address - Fax:
Practice Address - Street 1:1474 CALLE SALUD
Practice Address - Street 2:APT 13
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-5828
Practice Address - Country:US
Practice Address - Phone:787-674-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR151211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical