Provider Demographics
NPI:1730893744
Name:MILAN, CARLOS EDIEMIL SR (MSW)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDIEMIL
Last Name:MILAN
Suffix:SR
Gender:M
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:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1379
Mailing Address - Country:US
Mailing Address - Phone:787-714-2462
Mailing Address - Fax:
Practice Address - Street 1:CALLE SGTO GERARDO SANTIAGO
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-0070
Practice Address - Country:US
Practice Address - Phone:787-714-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR162891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical