Active NPI
Christy Rae Reynolds, LCSW
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1154792430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 17248
- Practice address
- 2121 San Diego Ave
San Diego, CA 92110-2928 - Phone
- (619) 497-8457
- Fax
- (619) 497-8295
- NPI assigned
- Oct 13, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 17248 | HI | Primary |
Addresses
Primary practice location
2121 San Diego Ave
San Diego, CA 92110-2928
Mailing address
2414 Front St Unit 15
San Diego, CA 92101-1439
Phone (716) 359-2608
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17248 | HI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444694400000",
"number": "1154792430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2414 FRONT ST UNIT 15",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921011439",
"telephone_number": "716-359-2608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 SAN DIEGO AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921102928",
"telephone_number": "619-497-8457",
"fax_number": "619-497-8295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "CHRISTY",
"middle_name": "RAE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-13",
"last_updated": "2015-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "HI",
"license": "17248",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.