=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467704007
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH A REYNOLDS PSY D PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2012
-----------------------------------------------------
Last Update Date | 07/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1660 EASTON RD
-----------------------------------------------------
City | WARRINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18976-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-262-9182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2767 MILL RD
-----------------------------------------------------
City | DOYLESTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18902-1657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH A REYNOLDS
-----------------------------------------------------
Credential | PSYPHD
-----------------------------------------------------
Telephone | 215-262-9182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0004X
-----------------------------------------------------
Taxonomy Name | Health Psychologist
-----------------------------------------------------
License Number | PS004613L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------