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NPI Code Detail

MEDICARE: MARILYN JOYCE REYNOLDS LCSW

MEDICARE: MARILYN JOYCE REYNOLDS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLC3656ME

General Provider Information

NPI Number : 1154386902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN JOYCE REYNOLDS LCSW
Provider Business Mailing Address
First Line : 26 APPLEGATE LN
Second Line :
City : FALMOUTH
State : ME
Zip : 04105-1743
Country : US
Telephone Number : 207-781-3539
Fax Number :
Provider Business Practice Location Address
First Line : 329 BATH RD
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-2673
Country : US
Telephone Number : 207-294-4657
Fax Number : 207-294-4649
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 06/01/2009

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