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NPI Code Detail

MEDICARE: STEPHEN ANTHONY REYNOLDS PSYD

MEDICARE: STEPHEN ANTHONY REYNOLDS PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist30232CA
2103TC0700XClinical PsychologistPSY-1750HI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12886-3412OTHERCAAMERICAN PSYCHOLOGICAL ASSOCIATION

General Provider Information

NPI Number : 1679906614
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN ANTHONY REYNOLDS PSYD
Provider Business Mailing Address
First Line : 1050 QUEEN ST STE 100
Second Line :
City : HONOLULU
State : HI
Zip : 96814-4130
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1050 QUEEN ST STE 100
Second Line :
City : HONOLULU
State : HI
Zip : 96814-4130
Country : US
Telephone Number : 808-207-5887
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2013
Last Update Date : 03/16/2022

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