Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 010398 | CT |
NPI | 1003358177 |
---|---|
Provider Name | Elsa Reyes |
First Address | Windsor, CT 06095-1722 |
Second Address | Manchester, CT 06040-3926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2016 |
Last Update Date | 06/11/2018 |