MEDICARE: SAMANTHA NICOLE REYES LMHC

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	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst
3	101YM0800X	Mental Health Counselor	012385	MA

General Provider Information

NPI Number	:	1942667324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA NICOLE REYES LMHC

Provider Business Mailing Address
First Line	:	511 E. COLUMBUS AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01105
Country	:	US
Telephone Number	:	413-827-8959
Fax Number	:

Provider Business Practice Location Address
First Line	:	2377 BOSTON RD STE 8
Second Line	:
City	:	WILBRAHAM
State	:	MA
Zip	:	01095-1254
Country	:	US
Telephone Number	:	413-722-5573
Fax Number	:

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

Provider Enumeration Date	:	01/15/2016
Last Update Date	:	03/31/2025

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