Individual
ERICA I REYNOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D. , LCSW
Contact information
Practice address
427 ENCINAL CANYON RD, MALIBU, CA 90265-2404
(818) 735-2805
Mailing address
PO BOX 10997, MARINA DEL REY, CA 90295-6997
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
25811
CA
1041C0700X
Clinical Social Worker
LCS 22233
CA
Other
Enumeration date
11/17/2006
Last updated
04/25/2021
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