Provider Demographics
NPI:1154684017
Name:CORENO -REYNOLDS, LAURIE JEAN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:JEAN
Last Name:CORENO -REYNOLDS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 PLANK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2042
Mailing Address - Country:US
Mailing Address - Phone:518-383-3356
Mailing Address - Fax:518-371-9936
Practice Address - Street 1:636 PLANK RD STE 111
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2042
Practice Address - Country:US
Practice Address - Phone:518-383-3356
Practice Address - Fax:518-371-9936
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000-41101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health