Provider Demographics
NPI:1962831909
Name:REYENGA, PATRICIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:REYENGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:STEPANICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3485 RAMBLING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-7046
Mailing Address - Country:US
Mailing Address - Phone:407-592-8503
Mailing Address - Fax:407-977-0354
Practice Address - Street 1:300 WILSHIRE BLVD
Practice Address - Street 2:SUITE 237
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5378
Practice Address - Country:US
Practice Address - Phone:407-592-8503
Practice Address - Fax:407-977-0354
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 115841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical