Provider Demographics
NPI:1558043380
Name:RENO, KAYLA DAWN (MSW INTERN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:DAWN
Last Name:RENO
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 DOWNEY ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2633
Mailing Address - Country:US
Mailing Address - Phone:505-480-3830
Mailing Address - Fax:
Practice Address - Street 1:3736 EUBANK BLVD NE STE B1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3583
Practice Address - Country:US
Practice Address - Phone:505-293-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-1289104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker