Provider Demographics
NPI:1407043169
Name:REYNOLDS, DEBORAH ANN (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 COOK RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9600
Mailing Address - Country:US
Mailing Address - Phone:513-896-7887
Mailing Address - Fax:513-896-5682
Practice Address - Street 1:212 COOK RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9600
Practice Address - Country:US
Practice Address - Phone:513-896-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0008873-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3023Medicaid
OH0280685Medicaid