Provider Demographics
NPI:1558935387
Name:REYES, JASON JOEL (PSY D)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JOEL
Last Name:REYES
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140783
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-201-2202
Mailing Address - Fax:
Practice Address - Street 1:155-199 CLL ARIZMENDI
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650
Practice Address - Country:US
Practice Address - Phone:787-822-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical