Healthcare Provider Details

I. General information

NPI: 1396632790
Provider Name (Legal Business Name): REAS CELA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LILAC ST
EAST HARTFORD CT
06118-1515
US

IV. Provider business mailing address

55 LILAC ST
EAST HARTFORD CT
06118-1515
US

V. Phone/Fax

Practice location:
  • Phone: 860-214-3612
  • Fax: 860-955-2415
Mailing address:
  • Phone: 860-214-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14931
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: