Provider Demographics
NPI:1356824635
Name:REYES, DINORA JIMINEZ
Entity Type:Individual
Prefix:
First Name:DINORA
Middle Name:JIMINEZ
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 N FEDERAL HWY STE 102F
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6510
Mailing Address - Country:US
Mailing Address - Phone:954-210-6070
Mailing Address - Fax:888-900-2325
Practice Address - Street 1:4699 N FEDERAL HWY STE 102F
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6510
Practice Address - Country:US
Practice Address - Phone:954-210-6070
Practice Address - Fax:888-900-2325
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW69051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical