Healthcare Provider Details

I. General information

NPI: 1336065200
Provider Name (Legal Business Name): JAZMIN REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 MAIN ST STE 401
NEW ROCHELLE NY
10801-6360
US

IV. Provider business mailing address

1241 NOBLE AVE APT 3
BRONX NY
10472-2800
US

V. Phone/Fax

Practice location:
  • Phone: 914-355-2440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: