Provider Demographics
NPI:1548481328
Name:REYNOLDS, BETTY J (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:J
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 GULF TO BAY BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4286
Mailing Address - Country:US
Mailing Address - Phone:727-241-8800
Mailing Address - Fax:727-241-7050
Practice Address - Street 1:2963 GULF TO BAY BLVD STE 320
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4286
Practice Address - Country:US
Practice Address - Phone:727-241-8800
Practice Address - Fax:727-241-7050
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW26251041C0700X
SW26251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765211900Medicaid