Provider Demographics
NPI:1306325949
Name:REYES PRADO, ODALIS (MSW)
Entity type:Individual
Prefix:MRS
First Name:ODALIS
Middle Name:
Last Name:REYES PRADO
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 1:100 CALLE BORINQUEN STE 705
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3818
Mailing Address - Country:US
Mailing Address - Phone:787-483-5468
Mailing Address - Fax:
Practice Address - Street 1:359 CALLE SAN CLAUDIO STE 202
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4257
Practice Address - Country:US
Practice Address - Phone:787-483-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2025-03-07
Deactivation Date:2023-05-09
Deactivation Code:
Reactivation Date:2023-07-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor