Provider Demographics
NPI:1376387530
Name:REID, JEANNETTE MASON (PHD)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:MASON
Last Name:REID
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MONTGOMERY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4248
Mailing Address - Country:US
Mailing Address - Phone:301-610-7850
Mailing Address - Fax:
Practice Address - Street 1:50 W MONTGOMERY AVE STE 110
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4248
Practice Address - Country:US
Practice Address - Phone:301-610-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical