Provider Demographics
NPI:1851149801
Name:REYES, JAYLIZA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:JAYLIZA
Middle Name:MARIE
Last Name:REYES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 5TH AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3435
Mailing Address - Country:US
Mailing Address - Phone:917-870-9397
Mailing Address - Fax:
Practice Address - Street 1:2177 5TH AVE APT 4D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3435
Practice Address - Country:US
Practice Address - Phone:917-870-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11623801104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker