Provider Demographics
NPI:1609185941
Name:REYNOLDS, MICHELLE DONOHUE (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DONOHUE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BOUTWELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-2434
Mailing Address - Country:US
Mailing Address - Phone:978-692-2810
Mailing Address - Fax:
Practice Address - Street 1:439 S UNION ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2837
Practice Address - Country:US
Practice Address - Phone:978-682-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker