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Individual

MARIE REYNOLDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
35 DOCK ST, ANDRUS CHILDREN'S CENTER, YONKERS, NY 10701-2733
(914) 966-1109
(914) 965-1663
Mailing address
1156 N BROADWAY, ANDRUS CHILDREN'S CENTER, YONKERS, NY 10701-1108
(914) 965-3700
(914) 965-3883

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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