Healthcare Provider Details

I. General information

NPI: 1780531269
Provider Name (Legal Business Name): DEYSI REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. DEYSI ISLA

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BROAD ST
NEWARK NJ
07102-3112
US

IV. Provider business mailing address

625 CENTRAL AVE
WESTFIELD NJ
07090-2524
US

V. Phone/Fax

Practice location:
  • Phone: 848-757-8776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00747000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: