Provider Demographics
NPI:1043310063
Name:REIS, DOREEN PEREIRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:PEREIRA
Last Name:REIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DOREEN
Other - Middle Name:PEREIRA
Other - Last Name:REIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:321 FORTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1750
Mailing Address - Country:US
Mailing Address - Phone:508-478-0207
Mailing Address - Fax:508-634-6984
Practice Address - Street 1:162 WEST ST
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4404
Practice Address - Country:US
Practice Address - Phone:860-613-9930
Practice Address - Fax:860-613-9952
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-12-12079103K00000X
CT03-4082221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical