Provider Demographics
NPI:1174080287
Name:NORALES, ODALIS CLARIVETH (MS)
Entity type:Individual
Prefix:
First Name:ODALIS
Middle Name:CLARIVETH
Last Name:NORALES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 E MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3444
Mailing Address - Country:US
Mailing Address - Phone:585-344-1421
Mailing Address - Fax:
Practice Address - Street 1:5130 E MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3444
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health