Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1053602417 |
---|---|
Provider Name | Dr. Elizabeth Keats Reynolds |
First Address | Baltimore, MD 21287-0001 |
Second Address | Baltimore, MD 21287-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 29/07/2013 |