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General NPI Number Information
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NPI Number | 1649835406
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Entity Type | Individual
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Provider Name | PHILLIP ANTHONY REYNOLDS
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Gender | Male
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 8120 WOODMONT AVE STE 205
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City | BETHESDA
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State | MD
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Zip | 20814-2784
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Country | US
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Telephone | 202-906-9588
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Fax | 202-403-3200
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Provider Business Mailing Address
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Address Line | 6 BRONCO CT
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City | GERMANTOWN
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State | MD
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Zip | 20874-6159
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Country | US
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Telephone | 301-325-2251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14543
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License Number State | MD
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