Provider Demographics
NPI:1215310727
Name:REYNOLDS, THERESA (BCBA)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25R PECK ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2207
Mailing Address - Country:US
Mailing Address - Phone:508-838-0284
Mailing Address - Fax:508-848-0101
Practice Address - Street 1:21 PARK ST
Practice Address - Street 2:SUITE 414
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2315
Practice Address - Country:US
Practice Address - Phone:844-825-5222
Practice Address - Fax:508-848-0101
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-18636103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst