MEDICARE: DR. RORY REID PH.D., 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
1	103T00000X	Psychologist
2	1041C0700X	Clinical Social Worker	7314-C	NV

General Provider Information

NPI Number	:	1679023196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RORY REID PH.D., LCSW

Provider Business Mailing Address
First Line	:	2218 SUMMERWIND CIR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2321
Country	:	US
Telephone Number	:	310-890-0599
Fax Number	:

Provider Business Practice Location Address
First Line	:	2218 SUMMERWIND CIR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2321
Country	:	US
Telephone Number	:	310-890-0599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	07/17/2020

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