Provider Demographics
NPI:1558142281
Name:DELAVILLEFROMOY, REESE (LMSW, CSW-INTERN)
Entity Type:Individual
Prefix:
First Name:REESE
Middle Name:
Last Name:DELAVILLEFROMOY
Suffix:
Gender:M
Credentials:LMSW, CSW-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3990
Mailing Address - Country:US
Mailing Address - Phone:702-947-2650
Mailing Address - Fax:
Practice Address - Street 1:3021 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3990
Practice Address - Country:US
Practice Address - Phone:702-947-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10399-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty