Provider Demographics
NPI:1306381462
Name:REYNOSO, MEGAN LOVE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LOVE
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LOVE
Other - Last Name:REYNOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3950 LOCH LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3208
Mailing Address - Country:US
Mailing Address - Phone:805-717-1173
Mailing Address - Fax:
Practice Address - Street 1:3950 LOCH LOMOND DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-3208
Practice Address - Country:US
Practice Address - Phone:805-717-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X
CA95916104100000X
CA1177811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker