Provider Demographics
NPI:1043945728
Name:SEVERINO, YERALIZ (MSW)
Entity type:Individual
Prefix:
First Name:YERALIZ
Middle Name:
Last Name:SEVERINO
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:HT3 CALLE JUAN F ACOSTA
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3730
Mailing Address - Country:US
Mailing Address - Phone:787-989-7999
Mailing Address - Fax:
Practice Address - Street 1:CARR. NO. 5 KM. 6.1 BO. JUAN SANCHEZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146251041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool