Provider Demographics
NPI:1780378380
Name:RONQUILLO, REINA (LMSW)
Entity type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:RONQUILLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FEDERALSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21632-1437
Mailing Address - Country:US
Mailing Address - Phone:410-754-5857
Mailing Address - Fax:833-914-0413
Practice Address - Street 1:302 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FEDERALSBURG
Practice Address - State:MD
Practice Address - Zip Code:21632-1437
Practice Address - Country:US
Practice Address - Phone:410-754-5857
Practice Address - Fax:833-914-0413
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30116104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker