| M.l. Reardon, Ph.d., Abpp | |
|
2411 Robeson St Suite 200 Fayetteville NC 28305-5576 | |
| (910) 609-1990 | |
| (910) 609-1993 |
| Full Name | M.l. Reardon, Ph.d., Abpp |
|---|---|
| Speciality | Psychologist |
| Location | 2411 Robeson St, Fayetteville, North Carolina |
| Authorized Official Name and Position | Maureen Lyons Reardon (OWNER) |
| Authorized Official Contact | 9106091990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M.l. Reardon, Ph.d., Abpp 5048 Bartons Enclave Ln Raleigh NC 27613-8564 Ph: (919) 800-1174 | M.l. Reardon, Ph.d., Abpp 2411 Robeson St Suite 200 Fayetteville NC 28305-5576 Ph: (910) 609-1990 |
| NPI Number | 1558810580 |
|---|---|
| Provider Enumeration Date | 10/03/2016 |
| Last Update Date | 10/12/2016 |
| Medicare PECOS PAC ID | 2860780954 |
|---|---|
| Medicare Enrollment ID | O20161005000548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558810580 | NPI | - | NPPES |
| 19K0B | Other | NC | BLUE CROSS BLUE SHIELD NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 103TF0200X | Psychologist - Forensic | 3149 (North Carolina) | Secondary |
| Provider Name | Maureen Lyons Reardon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750733564 PECOS PAC ID: 4587952676 Enrollment ID: I20161005000663 |
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