Provider Demographics
NPI:1114075272
Name:STRAUB, REINHARD WALTER (LICSW, LCDCS)
Entity Type:Individual
Prefix:MR
First Name:REINHARD
Middle Name:WALTER
Last Name:STRAUB
Suffix:
Gender:M
Credentials:LICSW, LCDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CAROLINA MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:RI
Mailing Address - Zip Code:02812-1030
Mailing Address - Country:US
Mailing Address - Phone:401-741-5109
Mailing Address - Fax:203-421-6608
Practice Address - Street 1:71 BRADLEY RD UNIT 6
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2662
Practice Address - Country:US
Practice Address - Phone:203-421-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
RIISW017301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical