Provider Demographics
NPI:1679824536
Name:REYNOLDS, PAUL (PSYD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MAXWELLS GRN
Mailing Address - Street 2:410
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2684
Mailing Address - Country:US
Mailing Address - Phone:857-991-9187
Mailing Address - Fax:
Practice Address - Street 1:127 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5732
Practice Address - Country:US
Practice Address - Phone:857-991-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical