Provider Demographics
NPI:1114119591
Name:REYES, DARA (PSYD)
Entity type:Individual
Prefix:MS
First Name:DARA
Middle Name:
Last Name:REYES
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E CHEVY CHASE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4140
Mailing Address - Country:US
Mailing Address - Phone:818-240-0340
Mailing Address - Fax:858-467-7161
Practice Address - Street 1:1560 E CHEVY CHASE DR STE 130
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4140
Practice Address - Country:US
Practice Address - Phone:818-240-0340
Practice Address - Fax:858-467-7161
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2025-03-28
Deactivation Date:2009-12-17
Deactivation Code:
Reactivation Date:2010-02-11
Provider Licenses
StateLicense IDTaxonomies
CAPSY 27297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical