MEDICARE: MR. REGINALD HARRIS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1653	CT

General Provider Information

NPI Number	:	1205174588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REGINALD HARRIS LMFT

Provider Business Mailing Address
First Line	:	2400 TAMARACK AVE STE 201
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-5559
Country	:	US
Telephone Number	:	860-550-3953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 TAMARACK AVE STE 201
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-5559
Country	:	US
Telephone Number	:	860-550-3953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	03/24/2026

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