Healthcare Provider Details

I. General information

NPI: 1104753755
Provider Name (Legal Business Name): YAMILERSY REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 E GLENWILD DRIVE
SMALLWOOD NY
12778
US

IV. Provider business mailing address

PO BOX 432
SMALLWOOD NY
12778-0432
US

V. Phone/Fax

Practice location:
  • Phone: 845-798-5968
  • Fax:
Mailing address:
  • Phone: 845-871-1000
  • Fax: 845-516-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3030333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: