Individual
MRS. LISA REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
3251 ROUTE 112, BLDG 9 SUITE 2, MEDFORD, NY 11763-1446
(631) 451-6007
(631) 297-8121
Mailing address
977 N OCEAN AVE, PATCHOGUE, NY 11772-1106
(631) 451-6007
(631) 297-8121
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22297
NY
Other
Enumeration date
03/24/2014
Last updated
03/24/2014
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