Healthcare Provider Details

I. General information

NPI: 1649587916
Provider Name (Legal Business Name): RAECHAEL MARIE REYES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RUGBY AVE FL 2
HUNTINGTON PARK CA
90255-4066
US

IV. Provider business mailing address

6330 RUGBY AVE FL 2
HUNTINGTON PARK CA
90255-4066
US

V. Phone/Fax

Practice location:
  • Phone: 213-334-1155
  • Fax:
Mailing address:
  • Phone: 213-224-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number74952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: