Provider Demographics
NPI:1386205417
Name:REYES GUTIERREZ, WENDY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:REYES GUTIERREZ
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1409
Mailing Address - Country:US
Mailing Address - Phone:301-789-3973
Mailing Address - Fax:
Practice Address - Street 1:1000 TWINBROOK PKWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1201
Practice Address - Country:US
Practice Address - Phone:301-424-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD218451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical