Provider Demographics
NPI:1942697750
Name:REYES, MICHELLE M (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:REYES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 BANNING ST STE 320
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3488
Mailing Address - Country:US
Mailing Address - Phone:302-632-8449
Mailing Address - Fax:302-674-0109
Practice Address - Street 1:200 BANNING ST STE 320
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3488
Practice Address - Country:US
Practice Address - Phone:302-674-0223
Practice Address - Fax:302-674-0109
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150041041C0700X
DEQ1-00014231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical