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General NPI Number Information
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NPI Number | 1306325949
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Entity Type | Individual
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Provider Name | ODALIS REYES PRADO MSW
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Gender | Female
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 359 CALLE SAN CLAUDIO STE 202
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City | SAN JUAN
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State | PR
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Zip | 00926-4257
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Country | US
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Telephone | 787-483-5468
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CALLE BORINQUEN STE 705
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-3818
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Country | US
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Telephone | 787-483-5468
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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