1558647198 NPI number — BRENDA W ENCARNACION REYES MASTER SOCIAL WORK

Table of content: BRENDA W ENCARNACION REYES MASTER SOCIAL WORK (NPI 1558647198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558647198 NPI number — BRENDA W ENCARNACION REYES MASTER SOCIAL WORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENCARNACION REYES
Provider First Name:
BRENDA
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASTER SOCIAL WORK
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558647198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729-0080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-645-1664
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 956 KIL 4.0 SECTOR ESTANCITAS
Provider Second Line Business Practice Location Address:
BO PALMA SOLA
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729-0080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-645-1664
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  10508 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10508 . This is a "NUMBER LICENSE SOCIAL WORK" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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