NPIMap

Organization Active NPI

Mareda L. Reynolds Ma PLLC

  • Clinical Psychologist
  • Saint Albans, WV
National Provider Identifier
1114027653
Registry record updated Oct 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
790 Issued in WV
Legal business name
MAREDA L. REYNOLDS MA PLLC
Practice address
200 Kanawha Ter
Suite 103
Saint Albans, WV 25177-2867
Phone
(304) 727-1302
Fax
(304) 727-1302
NPI assigned
Sep 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mareda Reynolds
Title
Owner
Phone
(304) 727-1302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 790 WV Primary

Addresses

Primary practice location

200 Kanawha Ter
Suite 103
Saint Albans, WV 25177-2867

Mailing address

PO Box 904
Saint Albans, WV 25177-0904
Phone (304) 727-1302

Other identifiers 1

IdentifierTypeStateIssuer
9204038000MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191715200000",
    "number": "1114027653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 904",
            "city": "SAINT ALBANS",
            "state": "WV",
            "postal_code": "251770904",
            "telephone_number": "304-727-1302",
            "fax_number": "304-727-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 KANAWHA TER",
            "address_2": "SUITE 103",
            "city": "SAINT ALBANS",
            "state": "WV",
            "postal_code": "251772867",
            "telephone_number": "304-727-1302",
            "fax_number": "304-727-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAREDA L. REYNOLDS MA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-24",
        "last_updated": "2007-10-07",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "MAREDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-727-1302"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WV",
            "license": "790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9204038000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Albans, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.