Provider Demographics
NPI:1730376856
Name:REY, AMELIA R (LCSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:R
Last Name:REY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3021
Mailing Address - Country:US
Mailing Address - Phone:305-785-7337
Mailing Address - Fax:
Practice Address - Street 1:3606 HYDE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:305-785-7337
Practice Address - Fax:305-785-7337
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0001743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health