Provider Demographics
NPI:1023583903
Name:REYES, GIANNINA K (MA)
Entity type:Individual
Prefix:
First Name:GIANNINA
Middle Name:K
Last Name:REYES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 ALLENTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1213
Mailing Address - Country:US
Mailing Address - Phone:484-578-9796
Mailing Address - Fax:
Practice Address - Street 1:5 S CENTRE AVE
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8653
Practice Address - Country:US
Practice Address - Phone:484-578-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional