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General NPI Number Information
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NPI Number | 1972670297
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Entity Type | Individual
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Provider Name | BARRY S. REYNOLDS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 2566 OVERLAND AVE SUITE 780
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City | LOS ANGELES
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State | CA
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Zip | 90064-3366
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Country | US
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Telephone | 213-740-6620
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Fax |
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Provider Business Mailing Address
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Address Line | 2566 OVERLAND AVE SUITE 780
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City | LOS ANGELES
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State | CA
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Zip | 90064-3366
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Country | US
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Telephone | 213-740-6620
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-5942
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License Number State | CA
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