Provider Demographics
NPI:1467475798
Name:REYNOLDS, MARY E (RNCS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:REYNOLDS
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Gender:F
Credentials:RNCS
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Mailing Address - Street 1:2 ESSEX CENTER DR
Mailing Address - Street 2:BH DEPT
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2930
Mailing Address - Country:US
Mailing Address - Phone:978-977-4320
Mailing Address - Fax:978-977-4335
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:BH DEPT
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2930
Practice Address - Country:US
Practice Address - Phone:978-977-4320
Practice Address - Fax:978-977-4335
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-10-13
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Provider Licenses
StateLicense IDTaxonomies
MA143712163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA680063OtherTUFTS HEALTH PLAN
MAPN0742OtherBLUE CROSS
MA0036949OtherNEIGHBORHOOD HEALTH PLAN
MAP42460Medicare UPIN
MANS0499Medicare ID - Type Unspecified