Provider Demographics
NPI:1952159915
Name:REYNOLDS, CAROLYN MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARY
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MARY
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:903 SNOWBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9429
Mailing Address - Country:US
Mailing Address - Phone:908-334-0100
Mailing Address - Fax:
Practice Address - Street 1:903 SNOWBERRY ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-9429
Practice Address - Country:US
Practice Address - Phone:908-334-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NJ44SL062592001041C0700X
CO099287551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical