MEDICARE: MARITZA ELVA REYES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	30533	TX

General Provider Information

NPI Number	:	1497853345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITZA ELVA REYES LCSW

Provider Business Mailing Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-250-0302
Fax Number	:

Provider Business Practice Location Address
First Line	:	3228 SCHOFIELD RD STE 103
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7603
Country	:	US
Telephone Number	:	210-808-3275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/20/2024

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