MEDICARE: MS. RENEE REYNOLDS LCSW

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
1	1041C0700X	Clinical Social Worker	9485	LA
2	104100000X	Social Worker	9485	LA

General Provider Information

NPI Number	:	1861679250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE REYNOLDS LCSW

Provider Business Mailing Address
First Line	:	2439 MANHATTAN BLVD STE 503A
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-5328
Country	:	US
Telephone Number	:	504-323-4380
Fax Number	:

Provider Business Practice Location Address
First Line	:	2439 MANHATTAN BLVD STE 503A
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-5328
Country	:	US
Telephone Number	:	504-323-4380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/08/2024

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