Provider Demographics
NPI:1568221059
Name:REYES, JAELYN MCKENZIE
Entity Type:Individual
Prefix:
First Name:JAELYN
Middle Name:MCKENZIE
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 1:23235 SCOTCH PINE CT
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-6118
Mailing Address - Country:US
Mailing Address - Phone:786-846-0080
Mailing Address - Fax:
Practice Address - Street 1:23235 SCOTCH PINE CT
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-6118
Practice Address - Country:US
Practice Address - Phone:786-846-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician