Provider Demographics
NPI:1568528016
Name:REYNOLDS, BRIAN F (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:F
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DAMONMILL SQ STE 3A1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2864
Mailing Address - Country:US
Mailing Address - Phone:978-287-4300
Mailing Address - Fax:978-369-0400
Practice Address - Street 1:9 DAMONMILL SQ STE 3A1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2864
Practice Address - Country:US
Practice Address - Phone:978-287-4300
Practice Address - Fax:978-369-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02635OtherBLUE CROSS-BLUE SHIELD
MA2517OtherPSYCHOLOGIST PROVIDER
MAW02635OtherBLUE CROSS-BLUE SHIELD