MEDICARE: SHARYL LYNNE REID 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	1041C0700X	Clinical Social Worker	16710	CA

General Provider Information

NPI Number	:	1689270324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARYL LYNNE REID LCSW

Provider Business Mailing Address
First Line	:	30495 CANWOOD ST STE 101
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4331
Country	:	US
Telephone Number	:	818-707-7366
Fax Number	:	818-306-5836

Provider Business Practice Location Address
First Line	:	30495 CANWOOD ST STE 101
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4331
Country	:	US
Telephone Number	:	818-707-7366
Fax Number	:	818-306-5836

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

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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