Provider Demographics
NPI:1134539919
Name:REYES-GARCIA, GUADALUPE (LCSW)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:REYES-GARCIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LUPITA
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:560 BUTTE CT
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-9635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 KERN ST STE D
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2257
Practice Address - Country:US
Practice Address - Phone:661-865-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA912181041C0700X
CAASW 632361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical