Healthcare Provider Details

I. General information

NPI: 1528997236
Provider Name (Legal Business Name): JANAY REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 MARYLAND RD APT C6
WILLOW GROVE PA
19090-1806
US

IV. Provider business mailing address

1348 SAINT CHARLES PL
ROSLYN PA
19001-2317
US

V. Phone/Fax

Practice location:
  • Phone: 267-475-9850
  • Fax:
Mailing address:
  • Phone: 267-475-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC019407
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: