MEDICARE: DR. BARRY S. REYNOLDS PH.D.

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	103TC0700X	Clinical Psychologist	PSY-5942	CA

General Provider Information

NPI Number	:	1972670297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY S. REYNOLDS PH.D.

Provider Business Mailing Address
First Line	:	2566 OVERLAND AVE
Second Line	:	SUITE 780
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3366
Country	:	US
Telephone Number	:	213-740-6620
Fax Number	:

Provider Business Practice Location Address
First Line	:	2566 OVERLAND AVE
Second Line	:	SUITE 780
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3366
Country	:	US
Telephone Number	:	213-740-6620
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	01/16/2009

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