Provider Demographics
NPI:1316018054
Name:REYES, JORGE E (LCSW)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:REYES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28340 BERYLWOOD PL
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1515
Mailing Address - Country:US
Mailing Address - Phone:213-458-1459
Mailing Address - Fax:
Practice Address - Street 1:23550 LYONS AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2520
Practice Address - Country:US
Practice Address - Phone:661-360-6792
Practice Address - Fax:661-430-5414
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271501041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical