Provider Demographics
NPI:1093044042
Name:REYES DE DISLA, LUZ E (MA)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:E
Last Name:REYES DE DISLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2030 W TILGHMAN ST
Mailing Address - Street 2:SUITE 105BN
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4354
Mailing Address - Country:US
Mailing Address - Phone:484-221-9136
Mailing Address - Fax:484-221-9130
Practice Address - Street 1:226 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3676
Practice Address - Country:US
Practice Address - Phone:484-221-9136
Practice Address - Fax:484-221-9130
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health