Provider Demographics
NPI:1861891491
Name:ESCOBAR VIDOT, JOSEFINA (MSW)
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:ESCOBAR VIDOT
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:A-8 CALLE RIACHUELO
Mailing Address - Street 2:ESTANCIAS DE VALLE VERDE
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0000
Mailing Address - Country:US
Mailing Address - Phone:787-549-4602
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE RIACHUELO
Practice Address - Street 2:ESTANCIAS DE VALLE VERDE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-9778
Practice Address - Country:US
Practice Address - Phone:787-549-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5089104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker