Healthcare Provider Details

I. General information

NPI: 1205763760
Provider Name (Legal Business Name): ODALYS DIAZ RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB PARQUES DE GUASIMAS A6 CALLE 4
ARROYO PR
00714
US

IV. Provider business mailing address

19 CALLE RUISENOR
ARROYO PR
00714-3069
US

V. Phone/Fax

Practice location:
  • Phone: 939-416-4949
  • Fax:
Mailing address:
  • Phone: 939-416-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17128
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: