Provider Demographics
NPI:1851761506
Name:REYNOLDS, JOANNE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ROBINSON STREET
Mailing Address - Street 2:GBHC/ CTRC
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904
Mailing Address - Country:US
Mailing Address - Phone:607-797-0680
Mailing Address - Fax:607-797-4315
Practice Address - Street 1:425 ROBINSON STREET
Practice Address - Street 2:GBHC
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904
Practice Address - Country:US
Practice Address - Phone:607-797-0680
Practice Address - Fax:607-797-4315
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0394191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical