Provider Demographics
NPI:1861882292
Name:REYNOLDS, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20399 ROUTE 19
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6134
Mailing Address - Country:US
Mailing Address - Phone:724-777-2677
Mailing Address - Fax:724-772-2669
Practice Address - Street 1:20399 ROUTE 19
Practice Address - Street 2:SUITE 110
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6134
Practice Address - Country:US
Practice Address - Phone:724-777-2677
Practice Address - Fax:724-772-2669
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health