Provider Demographics
NPI:1619688595
Name:REYES, RACHEL ERIN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ERIN
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 1:17 CONCORD ST # 2
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03220-4500
Mailing Address - Country:US
Mailing Address - Phone:781-801-7873
Mailing Address - Fax:603-410-1105
Practice Address - Street 1:57 REGIONAL DR STE 7
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8518
Practice Address - Country:US
Practice Address - Phone:603-224-7630
Practice Address - Fax:603-410-1105
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-22-63098103K00000X
NH1-22-63098103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst