Provider Demographics
NPI:1306381462
Name:REYNOSO, MEGAN SUZANNE (ASW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SUZANNE
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:SUZANNE
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1400 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5906
Mailing Address - Country:US
Mailing Address - Phone:855-882-9852
Mailing Address - Fax:
Practice Address - Street 1:1400 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5906
Practice Address - Country:US
Practice Address - Phone:855-882-9852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X
CA95916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health