Individual
ALISA ANN REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
201 E GREEN ST, ITHACA, NY 14850-5635
(607) 274-6200
Mailing address
100 ROBERTS ST APT 11-1, BINGHAMTON, NY 13901-2431
(607) 222-6231
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
103138
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588686596
—
NY
Enumeration date
03/25/2025
Last updated
03/25/2025
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