Provider Demographics
NPI:1558647198
Name:ENCARNACION REYES, BRENDA W (MASTER SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:W
Last Name:ENCARNACION REYES
Suffix:
Gender:F
Credentials:MASTER SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0080
Mailing Address - Country:US
Mailing Address - Phone:787-645-1664
Mailing Address - Fax:
Practice Address - Street 1:CARR 956 KIL 4.0 SECTOR ESTANCITAS
Practice Address - Street 2:BO PALMA SOLA
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0080
Practice Address - Country:US
Practice Address - Phone:787-645-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10508171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10508OtherNUMBER LICENSE SOCIAL WORK