Provider Demographics
NPI:1356480693
Name:REYES, ELIZABETH ANGELINA (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANGELINA
Last Name:REYES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2320
Mailing Address - Country:US
Mailing Address - Phone:817-714-0939
Mailing Address - Fax:817-335-4043
Practice Address - Street 1:1424 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5912
Practice Address - Country:US
Practice Address - Phone:817-335-4041
Practice Address - Fax:817-335-4043
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical