Healthcare Provider Details

I. General information

NPI: 1689856767
Provider Name (Legal Business Name): MARIELLA REANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 07/02/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDDAC-BAVARIA PSC 411 UNIT 28037
APO AE
09112
US

IV. Provider business mailing address

MEDDAC-BAVARIA PSC 411 UNIT 28037
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 573-433-1462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number50448
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: