Provider Demographics
NPI:1841521457
Name:REYES, ROSA (MA)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 SE FED HWY
Mailing Address - Street 2:LOT 188
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:772-485-1677
Mailing Address - Fax:
Practice Address - Street 1:7410 SW US HWY. 1
Practice Address - Street 2:SUITE 400
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1432
Practice Address - Country:US
Practice Address - Phone:772-340-5044
Practice Address - Fax:772-340-5916
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health