Provider Demographics
NPI:1982192902
Name:REYES, AIDE ROXANNA (MHC)
Entity Type:Individual
Prefix:
First Name:AIDE
Middle Name:ROXANNA
Last Name:REYES
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 METROPOLITAN AVE # 1
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-8329
Mailing Address - Country:US
Mailing Address - Phone:718-456-1016
Mailing Address - Fax:
Practice Address - Street 1:5805 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-8329
Practice Address - Country:US
Practice Address - Phone:718-456-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health