Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 23622 | NY |
Y | 1041C0700X | Clinical Social Worker | 082465 | NY |
NPI | 1003255050 |
---|---|
Provider Name | Mr. Adam Lloyd Reynolds |
First Address | Jackson Hts, NY 11372-7416 |
Second Address | Jackson Hts, NY 11372-7416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 21/06/2013 |