Provider Demographics
NPI:1407189004
Name:BARNES, REYNOLD LEE (LMHC, LADC1, CADAC)
Entity type:Individual
Prefix:MR
First Name:REYNOLD
Middle Name:LEE
Last Name:BARNES
Suffix:
Gender:M
Credentials:LMHC, LADC1, CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HIGHCREST RD
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4824
Mailing Address - Country:US
Mailing Address - Phone:857-719-7089
Mailing Address - Fax:508-233-7710
Practice Address - Street 1:79 STEDMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6008
Practice Address - Country:US
Practice Address - Phone:875-719-7089
Practice Address - Fax:508-233-7710
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1259AD101YA0400X
MA2157101YA0400X
MA7086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)