Provider Demographics
NPI:1568676377
Name:REYNOSO, MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J H8
Mailing Address - Street 2:URB. ALAMAR
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773
Mailing Address - Country:US
Mailing Address - Phone:787-889-6582
Mailing Address - Fax:
Practice Address - Street 1:H8 CALLE J
Practice Address - Street 2:URB. ALAMAR
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-2515
Practice Address - Country:US
Practice Address - Phone:787-889-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical