MEDICARE: CYNTHIA L 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	87001331A	IN
2	1041C0700X	Clinical Social Worker	34006007A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1632549	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1811029358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA L REYNOLDS LCSW

Provider Business Mailing Address
First Line	:	5660 CAITO DR
Second Line	:	SUITE 122
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1372
Country	:	US
Telephone Number	:	317-771-8913
Fax Number	:

Provider Business Practice Location Address
First Line	:	5660 CAITO DR
Second Line	:	SUITE 122
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1372
Country	:	US
Telephone Number	:	317-771-8913
Fax Number	:

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

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	11/22/2021

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