Individual
DR. TINA DICICCO REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
11401 NW 14TH CT, PEMBROKE PINES, FL 33026
(954) 787-9711
(954) 787-8116
Mailing address
11401 NW 14TH CT, PEMBROKE PINES, FL 33026-2505
(954) 249-1871
(954) 787-8116
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
PY 7384
FL
103TC0700X
Clinical Psychologist
Primary
PY 7384
FL
103TC2200X
Clinical Child & Adolescent Psychologist
PY 7384
FL
103TF0000X
Family Psychologist
PY 7384
FL
Other
Enumeration date
12/01/2006
Last updated
05/06/2021
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