Healthcare Provider Details

I. General information

NPI: 1538136734
Provider Name (Legal Business Name): MARY E REEVES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 GREENWOOD AVE
BETHEL CT
06801-2527
US

IV. Provider business mailing address

18 SHARP HILL LN
RIDGEFIELD CT
06877-3735
US

V. Phone/Fax

Practice location:
  • Phone: 203-240-9061
  • Fax:
Mailing address:
  • Phone: 203-240-9061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002352
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: