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Individual
MARIE REYNOLDS
Active
Individual
MARIE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00355940
AGENCY MEDICAID #
NY
01
—
1285628552
AGENCY NPI
NY
01
—
WVE061
AGENCY MEDICAID #
NY
Enumeration date
09/19/2007
Last updated
11/30/2007
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