Provider Demographics
NPI:1760109300
Name:REYES, CARMENOEMIANGELA DIUCO (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMENOEMIANGELA
Middle Name:DIUCO
Last Name:REYES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KARLET
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:210 N HIGHWAY 27 STE 4
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2411
Mailing Address - Country:US
Mailing Address - Phone:352-988-6673
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGHWAY 27 STE 4
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2411
Practice Address - Country:US
Practice Address - Phone:352-988-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4703106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist