Provider Demographics
NPI:1275600272
Name:REEDY, GINETTE D (LCSW)
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:D
Last Name:REEDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GINETTE
Other - Middle Name:
Other - Last Name:DIAZ-CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4910 AIRPORT AVE
Mailing Address - Street 2:BLDG D
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5759
Mailing Address - Country:US
Mailing Address - Phone:281-239-1369
Mailing Address - Fax:281-239-0828
Practice Address - Street 1:4910 AIRPORT AVE
Practice Address - Street 2:BLDG A
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5759
Practice Address - Country:US
Practice Address - Phone:281-239-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13183104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82447WMedicare ID - Type UnspecifiedTEXANA GROUP