Healthcare Provider Details

I. General information

NPI: 1528296985
Provider Name (Legal Business Name): REINALDO OQUENDO L.C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WETHERSFIELD AVE
HARTFORD CT
06114-1113
US

IV. Provider business mailing address

210 WETHERSFIELD AVE
HARTFORD CT
06114-1113
US

V. Phone/Fax

Practice location:
  • Phone: 860-296-0094
  • Fax: 860-206-1184
Mailing address:
  • Phone: 860-296-0094
  • Fax: 860-206-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number001483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: