Active NPI
Melitzie Fred
- Clinical Social Worker
- Canovanas, PR
National Provider Identifier
1609147990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 19108
- Practice address
- Loiza Valley Shopping Center
Local Aa-6
Canovanas, PR 00729 - Phone
- (787) 648-4863
- NPI assigned
- Jan 19, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 19108 | PR | Primary |
Addresses
Primary practice location
Loiza Valley Shopping Center
Local Aa-6
Canovanas, PR 00729
Mailing address
Loiza Valley Shopping Local Aa-6
Canovanas, PUERTO RICO 00729
UM
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19108 | PR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334188800000",
"number": "1609147990",
"addresses": [
{
"country_code": "UM",
"country_name": "United States Minor Outlying Islands",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "LOIZA VALLEY SHOPPING LOCAL AA-6",
"city": "CANOVANAS",
"state": "PUERTO RICO",
"postal_code": "00729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "LOIZA VALLEY SHOPPING CENTER",
"address_2": "LOCAL AA-6",
"city": "CANOVANAS",
"state": "PR",
"postal_code": "00729",
"telephone_number": "787-648-4863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRED",
"first_name": "MELITZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-19",
"last_updated": "2012-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PR",
"license": "19108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canovanas, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.