Active NPI
Brian F. Reynolds, PH.D.
- Clinical Psychologist
- Concord, MA
National Provider Identifier
1568528016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2517
- Practice address
- 9 Damonmill SQ Ste 3A1
Concord, MA 01742-2864 - Phone
- (978) 287-4300
- Fax
- (978) 369-0400
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 Psychologist | 103TC0700X | 2517 | MA | Primary |
Addresses
Primary practice location
9 Damonmill SQ Ste 3A1
Concord, MA 01742-2864
Mailing address
9 Damonmill SQ Ste 3A1
Concord, MA 01742-2864
Phone (978) 287-4300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W02635 | Other | MA | BLUE CROSS-BLUE SHIELD |
| 2517 | Other | MA | PSYCHOLOGIST PROVIDER |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2517 | MA | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elite Care Therapeutics, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Concord, MA
- NPI 1073295341
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568528016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 DAMONMILL SQ STE 3A1",
"city": "CONCORD",
"state": "MA",
"postal_code": "017422864",
"telephone_number": "978-287-4300",
"fax_number": "978-369-0400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 DAMONMILL SQ STE 3A1",
"city": "CONCORD",
"state": "MA",
"postal_code": "017422864",
"telephone_number": "978-287-4300",
"fax_number": "978-369-0400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "BRIAN",
"middle_name": "F.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "2517",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS-BLUE SHIELD",
"identifier": "W02635",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST PROVIDER",
"identifier": "2517",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.