Provider Demographics
NPI:1679700728
Name:ESTRADA, MARA L (MSW)
Entity type:Individual
Prefix:MISS
First Name:MARA
Middle Name:L
Last Name:ESTRADA
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 1:55 CALLE DEL CARMEN W
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4717
Mailing Address - Country:US
Mailing Address - Phone:787-860-3558
Mailing Address - Fax:787-860-3330
Practice Address - Street 1:55 CALLE DEL CARMEN W
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4717
Practice Address - Country:US
Practice Address - Phone:787-860-3558
Practice Address - Fax:787-860-3330
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR160351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical