Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 019853 | NY |
Y | 103TC0700X | Clinical Psychologist | 019853 | NY |
NPI | 1003153115 |
---|---|
Provider Name | Dr. Lorri Reynard |
First Address | New York, NY 10019-4640 |
Second Address | New York, NY 10019-4640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2013 |
Last Update Date | 10/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03627098 | (05) | NY |