Provider Demographics
NPI:1588971733
Name:REYNA, MARY C (PSYD)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:C
Last Name:REYNA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CIVIC CT STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7955
Mailing Address - Country:US
Mailing Address - Phone:925-671-0777
Mailing Address - Fax:
Practice Address - Street 1:2191 KIRKER PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521
Practice Address - Country:US
Practice Address - Phone:925-671-0777
Practice Address - Fax:925-685-0377
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32657103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical