Provider Demographics
NPI:1467997759
Name:REYNOLDS, BRIDGET BRIANNE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:BRIANNE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:BRIANNE
Other - Last Name:SINERIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:126 TALL OAKS RD
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-8975
Mailing Address - Country:US
Mailing Address - Phone:850-585-9189
Mailing Address - Fax:850-951-0898
Practice Address - Street 1:171 STATE HIGHWAY 83 UNIT A101
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-7427
Practice Address - Country:US
Practice Address - Phone:850-585-9189
Practice Address - Fax:850-951-0898
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-7030-20402106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician