DR. DEBORAH JEANNE PETKOVSEK REYES (NPI# 1659471977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659471977 |
| Entity Type | Individual |
| Full Name | DR. DEBORAH JEANNE PETKOVSEK REYES |
| Credential | PH.D. |
| Practice Address |
4900 Broad River Rd Scdjj -bwd Campus Columbia SC 29212-3531 |
| Mailing Address |
2906 Burney Dr Columbia SC 29205-3418 |
| Practice Telephone | 8038969053 |
| Mailing Telephone | 8034766799 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2009-03-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
1038 | SC | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003270570 | Deborah Reyes | Dietitian, Registered | 3215 Winter Lake Road, Lakeland, FL 33803 | 2016-04-11 |
| 1861817686 | Deborah Reyes | Social Worker | 35 Market St, Lowell, MA 01852-6245 | 2014-03-03 |
| Street Address |
4900 BROAD RIVER RD SCDJJ -BWD CAMPUS |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29212-3531 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679931679 | Debbie Lemus | Social Worker | 4900 Broad River Rd, Columbia, SC 29212-3531 | 2016-02-04 |
| 1134556038 | Scdjj | Community/Behavioral Health | 4900 Broad River Rd, Columbia, SC 29212-3531 | 2013-10-09 |
| 1275872202 | Scdjj | Case Management | 4900 Broad River Rd, Columbia, SC 29212-3531 | 2013-02-12 |
| 1891031175 | Department of Juvenile Justice | Case Management | 4900 Broad River Rd, Columbia, SC 29212-3531 | 2012-12-14 |
| 1720324007 | Anthony Rochell Nelson Sr. | Social Worker | 4900 Broad River Rd, Columbia, SC 29212-3531 | 2012-12-14 |
| 1407191109 | Maxine Barker | Psychologist | 4900 Broad River Rd, Columbia, SC 29212-3531 | 2012-12-06 |
| 1629312558 | Alexander Grossberg | Social Worker | 4900 Broad River Rd, Columbia, SC 29212-3531 | 2012-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245758887 | Amanda Gail Holloman | Pharmacist | 6021 St. Andrews Road, Columbia, SC 29212 | 2017-09-04 |
| 1578080180 | Alvin Mitchell Jr. | Non-emergency Medical Transport (VAN) | 10 Breezewood Court, Columbia, SC 29212 | 2017-08-24 |
| 1467975102 | Shelby Clemmer | Behavior Technician | 2 Harbison Way, Columbia, SC 29212 | 2017-07-25 |
| 1982149019 | Showntellem | Private Vehicle | 336 Foxfire Dr, Columbia, SC 29212 | 2016-12-28 |
| 1902215296 | Miranda Willis Adult Day Care, LLC | Social Worker | 5932 Mcmillian Circle, Columbia, SC 29212 | 2014-08-12 |
| 1013342591 | Robert Glendon Long | Pediatrics | 15 Woodpine Ct, Columbia, SC 29212 | 2013-09-04 |
| 1174969638 | Melinda Dumas Crenshaw | Psychologist | 2800 Ashland Rd., Columbia, SC 29212 | 2013-05-10 |
| 1417209982 | Physician Services LLC | Internal Medicine | 214 Lake Front Drive, Physician Services, Cola, SC 29212 | 2012-10-09 |
| 1306131800 | Rocky Mountain Holdings LLC | Ambulance | 6015 Saint Andrews Rd, Columbia, SC 29212 | 2011-06-13 |
| 1023262839 | Candace Anne Aguiar | Nurse Anesthetist, Certified Registered | 400 Palmetto Health Pkwy, Palmetto Health Baptist Parkridge, Columbia, SC 29212 | 2008-11-06 |
| Find all providers in zip 29212 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215541040 | Charles A Burgess | Psychologist | 119 Parker Hall, Columbia, MO 65211-2340 | 2020-08-31 |
| 1851910335 | Columbia Psychology Healing Center LLC | Psychologist | 1900 N Providence Rd Ste 327, Columbia, MO 65202-3710 | 2020-04-14 |
| 1518515097 | Warrenetta Crawford Mann | Psychologist | 1409 Devine Street Thomson Building, Columbia, SC 29208-0001 | 2019-08-28 |
| 1528523420 | Daniel Franco | Psychologist | 4501 Kentsfield Ln, Columbia, MO 65201-3587 | 2019-02-05 |
| 1861964207 | Erin Joy Schuyler | Psychologist | 26 Barn Owl Ct, Columbia, SC 29209-4488 | 2018-12-26 |
| 1467944439 | Zixuan Wang | Psychologist | 10000 Town Center Ave Apt 434, Columbia, MD 21044-5447 | 2018-06-05 |
| 1366990384 | Amanda Marie Jones | Psychologist | 6851 Oak Hall Ln Ste 118, Columbia, MD 21045-5815 | 2016-09-19 |
| 1124574850 | Patrick Steele | Psychologist | 1531 Laurel St, Columbia, SC 29201 | 2016-09-01 |
| 1073968061 | Tara Acevedo, Psy.d., PC | Psychologist | 6213 Deep Earth Ln, Columbia, MD 21045-2565 | 2016-04-27 |
| 1467833798 | Matthew Edmond Fitzgerald | Psychologist | 6801 Oak Hall Ln # 2254, Columbia, MD 21045-9998 | 2015-06-11 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.