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General NPI Number Information
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NPI Number | 1356535850
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Entity Type | Individual
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Provider Name | MICHELLE MONACO REYNOLDS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 11 WOODLAND RD STE 2
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City | MADISON
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State | CT
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Zip | 06443-2380
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Country | US
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Telephone | 203-208-8996
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Fax | 203-204-1381
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Provider Business Mailing Address
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Address Line | 90 ROYAL OAK DR
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City | DURHAM
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State | CT
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Zip | 06422-1410
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Country | US
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Telephone | 203-376-8284
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Fax | 203-204-1381
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002786
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License Number State | CT
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