Provider Demographics
NPI:1932786472
Name:REYES-MENDEZ, NAHOMI ROSA
Entity Type:Individual
Prefix:MISS
First Name:NAHOMI
Middle Name:ROSA
Last Name:REYES-MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2112
Mailing Address - Country:US
Mailing Address - Phone:617-704-0718
Mailing Address - Fax:
Practice Address - Street 1:2 CLARK STREET
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:508-660-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health