Provider Demographics
NPI:1588623771
Name:REYNOLDS, KRISTEN JANE (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JANE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2134
Mailing Address - Country:US
Mailing Address - Phone:508-752-5191
Mailing Address - Fax:
Practice Address - Street 1:25 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3363
Practice Address - Country:US
Practice Address - Phone:978-840-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110855104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker