Healthcare Provider Details

I. General information

NPI: 1124217468
Provider Name (Legal Business Name): MS. HOPE ANNE REAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S QUEEN ST BERKELEY COUNTY BOARD OF EDUCATION
MARTINSBURG WV
25401-3233
US

IV. Provider business mailing address

649 FRONT ROYAL PIKE
WINCHESTER VA
22602-7323
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3500
  • Fax:
Mailing address:
  • Phone: 540-662-1816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberIP21012
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: