Provider Demographics
NPI:1346798113
Name:REYES, DIANNETTE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DIANNETTE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 4354
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-8922
Mailing Address - Country:US
Mailing Address - Phone:787-715-1260
Mailing Address - Fax:787-715-3621
Practice Address - Street 1:HC 4 BOX 4354
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-715-1260
Practice Address - Fax:787-715-3621
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR115331041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11533OtherCLINICAL SOCIAL WORK
PR11533OtherSOCIAL WORK