Healthcare Provider Details

I. General information

NPI: 1497933659
Provider Name (Legal Business Name): JOAN M. REID LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 BENNETTS CORNERS RD
MEMPHIS NY
13112-8726
US

IV. Provider business mailing address

6633 BENNETTS CORNERS RD
MEMPHIS NY
13112-8726
US

V. Phone/Fax

Practice location:
  • Phone: 315-689-7288
  • Fax:
Mailing address:
  • Phone: 315-689-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004108-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: