Provider Demographics
NPI:1861167561
Name:BURGOS, MARIANGELIS (MSW)
Entity type:Individual
Prefix:
First Name:MARIANGELIS
Middle Name:
Last Name:BURGOS
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:HC 7 BOX 2331
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9206
Mailing Address - Country:US
Mailing Address - Phone:939-248-4292
Mailing Address - Fax:
Practice Address - Street 1:URB. GLENVIEW GARDEN CALLE GLEN
Practice Address - Street 2:F21 APARTAMENTO A
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:939-248-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR248551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical