Provider Demographics
NPI:1124722889
Name:REYES, DEBORAH LEE (LICSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEE
Last Name:REYES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 LAKE CITY WAY NE APT 510
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7758
Mailing Address - Country:US
Mailing Address - Phone:206-226-7807
Mailing Address - Fax:
Practice Address - Street 1:825 EASTLAKE AVE E # G6-100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4405
Practice Address - Country:US
Practice Address - Phone:206-606-1424
Practice Address - Fax:206-606-1024
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610469881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical