Provider Demographics
NPI:1356101398
Name:REYES, CARMEN L (LMSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:REYES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:L
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:34 W 134TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2535
Mailing Address - Country:US
Mailing Address - Phone:917-250-4819
Mailing Address - Fax:
Practice Address - Street 1:631 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5039
Practice Address - Country:US
Practice Address - Phone:212-942-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122906-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker