Provider Demographics
NPI:1871857367
Name:REYNOLDS, SHANDA M (LMHC, EDD)
Entity type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMHC, EDD
Other - Prefix:
Other - First Name:SHANDA
Other - Middle Name:
Other - Last Name:LAZARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 PLEASANT ST # 248
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4904
Mailing Address - Country:US
Mailing Address - Phone:413-486-0337
Mailing Address - Fax:844-294-9214
Practice Address - Street 1:158 MAPLE ST APT A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2638
Practice Address - Country:US
Practice Address - Phone:413-636-2872
Practice Address - Fax:844-294-9214
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health