Healthcare Provider Details

I. General information

NPI: 1538859970
Provider Name (Legal Business Name): MICHELLE N REYES-LEAL ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 YALE AVE
CLAREMONT CA
91711-4340
US

IV. Provider business mailing address

6635 W HAPPY VALLEY RD STE A104-621
GLENDALE AZ
85310-2609
US

V. Phone/Fax

Practice location:
  • Phone: 909-621-6184
  • Fax:
Mailing address:
  • Phone: 602-358-7073
  • Fax: 888-927-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23274
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: