Provider Demographics
NPI:1235929381
Name:REYES, DOREEN ALEXANDRIA (LMT, CAGS)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:ALEXANDRIA
Last Name:REYES
Suffix:
Gender:F
Credentials:LMT, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SAVORY DR
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4920
Mailing Address - Country:US
Mailing Address - Phone:860-490-2719
Mailing Address - Fax:
Practice Address - Street 1:2 S BRIDGE DR
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2015
Practice Address - Country:US
Practice Address - Phone:413-388-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X
MA18549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No175M00000XOther Service ProvidersMidwife, Lay