Provider Demographics
NPI:1659930394
Name:REYES, DIOSSANTA (LMFT)
Entity Type:Individual
Prefix:
First Name:DIOSSANTA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 PENN AVE # 1W
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2076
Mailing Address - Country:US
Mailing Address - Phone:484-258-9215
Mailing Address - Fax:
Practice Address - Street 1:1161 PENN AVE # 1W
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2076
Practice Address - Country:US
Practice Address - Phone:484-258-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PAMFT001357106H00000X
PA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1659930394Medicaid