Provider Demographics
NPI:1417254590
Name:REYNOLDS, BRITTANY N (LISW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:N
Other - Last Name:BYNUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:7635 GOLDENROD DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR ON THE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3309
Mailing Address - Country:US
Mailing Address - Phone:740-322-4799
Mailing Address - Fax:
Practice Address - Street 1:202 E BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2058
Practice Address - Country:US
Practice Address - Phone:440-260-8300
Practice Address - Fax:440-260-8305
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.10020691041C0700X
OHI.14508721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid