Healthcare Provider Details

I. General information

NPI: 1386623650
Provider Name (Legal Business Name): HOWARD LAWRENCE REYES MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5142 BOX MDG
APO AP
96368-5142
US

IV. Provider business mailing address

18 MDG UNIT 5142
APO AP
96368-5142
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-5582
  • Fax:
Mailing address:
  • Phone: 315-634-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3228
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: