Provider Demographics
NPI:1083890727
Name:REYNOLDS, SANDRA JEAN
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15A BOLTON PLACE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-427-4383
Mailing Address - Fax:508-584-4328
Practice Address - Street 1:15 BOLTON PL
Practice Address - Street 2:15A
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5316
Practice Address - Country:US
Practice Address - Phone:508-427-4383
Practice Address - Fax:508-584-4328
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health