Provider Demographics
NPI:1700448453
Name:SOCO REY THERAPY, A LICENSED CLINICAL SOCIAL WORKER CORP
Entity Type:Organization
Organization Name:SOCO REY THERAPY, A LICENSED CLINICAL SOCIAL WORKER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOCORRO
Authorized Official - Middle Name:MARIZA
Authorized Official - Last Name:REYNOSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-383-8586
Mailing Address - Street 1:302 E MANCHESTER BLVD # 203
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1815
Mailing Address - Country:US
Mailing Address - Phone:323-383-8586
Mailing Address - Fax:
Practice Address - Street 1:302 E MANCHESTER BLVD # 203
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1815
Practice Address - Country:US
Practice Address - Phone:323-383-8586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)