Provider Demographics
NPI:1275762049
Name:REYNA, LINDA (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:REYNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:GALVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 6020
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616
Mailing Address - Country:US
Mailing Address - Phone:949-232-8193
Mailing Address - Fax:949-861-4967
Practice Address - Street 1:166 STONECLIFFE AISLE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603
Practice Address - Country:US
Practice Address - Phone:949-232-8193
Practice Address - Fax:949-861-4967
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical