Doctor Name: | MR. GREGORY HOMAN REYNOLDS |
NPI Number: | 1760750921 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CASAC, LMSW |
License Number: | 24431 |
Business Practice Address: | 40a Main St Westhampton Beach, NY - 119782673 |
Business Phone Number: | 6312881954 |
Business Fax Number: | 6312881955 |
Mailing Address: | 40a Main St, WESTHAMPTON BEACH |
State: | NY |
Postal Code: | 119782673 |
Phone Number: | 6312881954 |
Fax Number: | 6312881955 |
NPI Enumeration Date: | 12/02/2011 |
NPI Last Update Date: | 12/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 24431 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |