Provider Demographics
NPI:1609337179
Name:ALONSO-ROMAN, EDNA SARANIL (COUNSELOR)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:SARANIL
Last Name:ALONSO-ROMAN
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0274
Mailing Address - Country:US
Mailing Address - Phone:787-637-0763
Mailing Address - Fax:
Practice Address - Street 1:LOPEZ HORMAZABAL ST. 16
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-637-0763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4383101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4383OtherPROFESSIONAL COUNSELOR LICENSE