Provider Demographics
NPI:1336401827
Name:REYNOLDS, MARLENE (MSED)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PENNSYLVANIA AVE
Mailing Address - Street 2:PO BOX 588
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904-1762
Mailing Address - Country:US
Mailing Address - Phone:607-737-5566
Mailing Address - Fax:607-737-5480
Practice Address - Street 1:425 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-1762
Practice Address - Country:US
Practice Address - Phone:607-737-5566
Practice Address - Fax:607-737-5480
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management