Individual
DR. MAUREEN LYONS REARDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3149
NC
103TF0200X
Forensic Psychologist
3149
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558810580
PTAN TYPE II
NC
01
—
19K0B
BCBS NC
NC
Enumeration date
07/05/2016
Last updated
07/21/2022
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