Provider Demographics
NPI:1447629209
Name:AGOSTO, GLORIMAR
Entity type:Individual
Prefix:
First Name:GLORIMAR
Middle Name:
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 SAN LUIS
Mailing Address - Street 2:EDIF. NEWPORT IV
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922
Mailing Address - Country:US
Mailing Address - Phone:787-946-2625
Mailing Address - Fax:
Practice Address - Street 1:342 SAN LUIS
Practice Address - Street 2:EDIF. NEWPORT IV
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-679-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17283104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker