Provider Demographics
NPI:1386328763
Name:REYES, SEPHORA L (MHC)
Entity type:Individual
Prefix:
First Name:SEPHORA
Middle Name:L
Last Name:REYES
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E 5TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6958
Mailing Address - Country:US
Mailing Address - Phone:347-852-0892
Mailing Address - Fax:
Practice Address - Street 1:FOOTPRINTS MENTAL HEALTH COUNSELING
Practice Address - Street 2:3249 KINGSBRIDGE AVE
Practice Address - City:BRONX, NY
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:646-204-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health