1003033945 NPI number — DEANA REYNOLDS RIOS LCPC

Table of content: DEANA REYNOLDS RIOS LCPC (NPI 1003033945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003033945 NPI number — DEANA REYNOLDS RIOS LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS RIOS
Provider First Name:
DEANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNOLDS
Provider Other First Name:
DEANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003033945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2924
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLATA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20646-2984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-609-9887
Provider Business Mailing Address Fax Number:
301-609-7284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 RADIO STATION ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-609-9887
Provider Business Practice Location Address Fax Number:
301-609-7284
Provider Enumeration Date:
04/20/2007

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: 101YP2500X , with the licence number:  LC2147 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 58956180 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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