MEDICARE: MS. JESSICA D. REYES LMSW

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	104100000X	Social Worker	54846	TX

General Provider Information

NPI Number	:	1316387566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA D. REYES LMSW

Provider Business Mailing Address
First Line	:	4515 SANDAGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-2036
Country	:	US
Telephone Number	:	817-929-5757
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 SANDAGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-2036
Country	:	US
Telephone Number	:	817-929-5757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	07/02/2013

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