Provider Demographics
NPI:1932084761
Name:OSORIO, ODALIS ARACELIS
Entity type:Individual
Prefix:
First Name:ODALIS
Middle Name:ARACELIS
Last Name:OSORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 SW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-6309
Mailing Address - Country:US
Mailing Address - Phone:754-204-4335
Mailing Address - Fax:
Practice Address - Street 1:801 E BOULEVARD CHATELAINE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2234
Practice Address - Country:US
Practice Address - Phone:786-942-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician