Provider Demographics
NPI:1710647391
Name:REYNOLDS, LEAH (MSW,LSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 S MILDRED ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2824
Mailing Address - Country:US
Mailing Address - Phone:215-206-3317
Mailing Address - Fax:
Practice Address - Street 1:813 S MILDRED ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2824
Practice Address - Country:US
Practice Address - Phone:215-206-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137766104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker