Healthcare Provider Details

I. General information

NPI: 1255852612
Provider Name (Legal Business Name): ABIMAEL PRADO JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PUTNAM AVE STE 2A
PORTERVILLE CA
93257-3257
US

IV. Provider business mailing address

590 W PUTNAM AVE STE 2A
PORTERVILLE CA
93257-3257
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-3700
  • Fax: 559-781-1230
Mailing address:
  • Phone: 559-781-3700
  • Fax: 559-781-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75671
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: