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NPI Code Detail

MEDICARE: CARISSA REYES CSW

MEDICARE: CARISSA REYES CSW
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
11041C0700XClinical Social Worker11782053-3502UT
2104100000XSocial Worker11782053-3502UT

General Provider Information

NPI Number : 1730705955
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA REYES CSW
Provider Business Mailing Address
First Line : 11618 S STATE ST STE 1604
Second Line :
City : DRAPER
State : UT
Zip : 84020-7123
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11618 S STATE ST STE 1604
Second Line :
City : DRAPER
State : UT
Zip : 84020-7123
Country : US
Telephone Number : 385-202-5645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2020
Last Update Date : 09/29/2020

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Directions to “ CARISSA REYES CSW” Practice Location

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