Provider Demographics
NPI:1790009470
Name:REYES, CASSANDRA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
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 1:102 ALBEMARLE RD
Mailing Address - Street 2:APT. A7
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2354
Mailing Address - Country:US
Mailing Address - Phone:646-981-7117
Mailing Address - Fax:
Practice Address - Street 1:102 ALBEMARLE RD
Practice Address - Street 2:APT. A7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2354
Practice Address - Country:US
Practice Address - Phone:646-981-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor