MEDICARE: REY OF LIGHT THERAPY SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1063200913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REY OF LIGHT THERAPY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	1261 CHURCH ST APT 14
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02745-1758
Country	:	US
Telephone Number	:	508-971-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 CHURCH ST APT 14
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02745-1758
Country	:	US
Telephone Number	:	508-971-9910
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ MENTAL HEALTH CLINICIAN
Name	:	MRS. PRISCILLA SANTIAGO
Credential	:	LICSW
Telephone Number	:	508-538-4777

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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