Healthcare Provider Details

I. General information

NPI: 1689269797
Provider Name (Legal Business Name): BRIDGET V REYNOLDS MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 1/2 WALNUT ST REAR UNIT
EAST PROVIDENCE RI
02914-4426
US

IV. Provider business mailing address

68 1/2 WALNUT ST REAR UNIT
EAST PROVIDENCE RI
02914-4426
US

V. Phone/Fax

Practice location:
  • Phone: 401-321-4408
  • Fax:
Mailing address:
  • Phone: 401-321-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number18212
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: