Provider Demographics
NPI:1336872399
Name:REYNOLDS, MELISSA JOY (BEHAVIORAL INTERVENT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOY
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BEHAVIORAL INTERVENT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:REYNOLDS
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS EDUCATION
Mailing Address - Street 1:500 FAIRWAY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1817
Mailing Address - Country:US
Mailing Address - Phone:354-347-3736
Mailing Address - Fax:
Practice Address - Street 1:500 FAIRWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:DEERFIELD BCH
Practice Address - State:FL
Practice Address - Zip Code:33441-1819
Practice Address - Country:US
Practice Address - Phone:954-947-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician