Provider Demographics
NPI:1972565729
Name:REYNOLDS, BRADLEY S
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:S
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WACHUSETT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6913
Mailing Address - Country:US
Mailing Address - Phone:781-367-7903
Mailing Address - Fax:
Practice Address - Street 1:218 EAST RD
Practice Address - Street 2:HAMPSTEAD HOSPITAL
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2305
Practice Address - Country:US
Practice Address - Phone:603-329-5311
Practice Address - Fax:603-329-9374
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical