Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | PY7474 | FL |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY7474 | FL |
NPI | 1124351473 |
---|---|
Provider Name | Mary Beatrice Reyes |
First Address | Miami, FL 33136-3212 |
Second Address | Miami, FL 33136-3212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2009 |
Last Update Date | 09/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
472993025 | TAX ID (01) | FL |