Basic Information
| Provider Information | |||||||||
| NPI: | 1851804439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRADO | ||||||||
| FirstName: | MARYORI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2533 SW 19TH AVE APT 505 | ||||||||
| Address2: | |||||||||
| City: | COCONUT GROVE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331332465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863484381 | ||||||||
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| Practice Location | |||||||||
| Address1: | 654 NE 9TH PL | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330304934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052483488 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2017 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.