Individual
MARY BETH REYNOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2906 S 20TH ST, MILWAUKEE, WI 53215-3732
(920) 905-2865
Mailing address
PO BOX 778789, CHICAGO, IL 60677-8789
(414) 672-1353
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
8410-123
WI
Other
Enumeration date
11/12/2013
Last updated
08/14/2023
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