Provider Demographics
NPI:1144737420
Name:FRANCO REYES, VANESSA I (BA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:FRANCO REYES
Suffix:I
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:FRANCO REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:350 CALLE CARLOS F CARDON 500
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-622-3000
Mailing Address - Fax:
Practice Address - Street 1:474 AVE DE DIEGO
Practice Address - Street 2:COND DE DIEGO CHALETS APTO 66
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-622-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11709104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker