Provider Demographics
NPI:1720122310
Name:REYES, BLANCA ESTELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:ESTELA
Last Name:REYES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0715
Mailing Address - Country:US
Mailing Address - Phone:787-298-6370
Mailing Address - Fax:
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:SUITE 205
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-298-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR619103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent