Provider Demographics
NPI:1124351473
Name:REYES, MARY BEATRICE (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BEATRICE
Last Name:REYES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BEATRICE
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, PA
Mailing Address - Street 1:1009 NW 5TH AVE
Mailing Address - Street 2:JEFFERSON REAVES HEALTH CENTER
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3212
Mailing Address - Country:US
Mailing Address - Phone:786-466-4000
Mailing Address - Fax:305-585-4405
Practice Address - Street 1:1009 NW 5TH AVE
Practice Address - Street 2:JEFFERSON REAVES HEALTH CENTER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-3212
Practice Address - Country:US
Practice Address - Phone:786-466-4000
Practice Address - Fax:305-585-4405
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7474101YP1600X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL472993025OtherTAX ID