1871857367 NPI number — MRS. SHANDA M REYNOLDS LMHC, ED.D

Table of content: MRS. SHANDA M REYNOLDS LMHC, ED.D (NPI 1871857367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871857367 NPI number — MRS. SHANDA M REYNOLDS LMHC, ED.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS
Provider First Name:
SHANDA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, ED.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAZARE
Provider Other First Name:
SHANDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871857367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 PLEASANT ST # 248
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02148-4904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-486-0337
Provider Business Mailing Address Fax Number:
844-294-9214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
158 MAPLE ST APT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01105-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-636-2872
Provider Business Practice Location Address Fax Number:
844-294-9214
Provider Enumeration Date:
06/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7098 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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