Provider Demographics
NPI:1902174030
Name:REYES, GRISELL RODRIGUEZ (MS)
Entity Type:Individual
Prefix:
First Name:GRISELL
Middle Name:RODRIGUEZ
Last Name:REYES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CALLE WASHINTONIA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9258
Mailing Address - Country:US
Mailing Address - Phone:787-448-5011
Mailing Address - Fax:
Practice Address - Street 1:1790 CALLE JULIO AYBAR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4410
Practice Address - Country:US
Practice Address - Phone:787-448-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1517103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist