Provider Demographics
NPI:1780816454
Name:REYNOLDS, ABIGAIL JOY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:JOY
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4297
Mailing Address - Country:US
Mailing Address - Phone:781-223-2342
Mailing Address - Fax:617-591-0239
Practice Address - Street 1:111 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4297
Practice Address - Country:US
Practice Address - Phone:781-223-2342
Practice Address - Fax:617-591-0239
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-070941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical