Provider Demographics
NPI:1750733564
Name:REARDON, MAUREEN LYONS (PHD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:LYONS
Last Name:REARDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 STRICKLAND RD.
Mailing Address - Street 2:SUITE 114-331
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613
Mailing Address - Country:US
Mailing Address - Phone:919-800-1174
Mailing Address - Fax:919-400-4535
Practice Address - Street 1:2500 REGENCY PARKWAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-800-1174
Practice Address - Fax:919-400-4535
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3149103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558810580OtherPTAN TYPE II
NC19K0BOtherBCBS NC