Provider Demographics
NPI:1609606557
Name:TELLES, GLORIAN (MSW)
Entity type:Individual
Prefix:
First Name:GLORIAN
Middle Name:
Last Name:TELLES
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:RR 4 BOX 827922
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9430
Mailing Address - Country:US
Mailing Address - Phone:939-400-8494
Mailing Address - Fax:
Practice Address - Street 1:RR 4 BOX 827922
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-9430
Practice Address - Country:US
Practice Address - Phone:939-400-8494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12822104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker