Provider Demographics
NPI:1346518800
Name:REDA, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:REDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HOYT ST
Mailing Address - Street 2:4B
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5608
Mailing Address - Country:US
Mailing Address - Phone:914-299-5967
Mailing Address - Fax:
Practice Address - Street 1:43 HOYT ST
Practice Address - Street 2:4B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5608
Practice Address - Country:US
Practice Address - Phone:914-299-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist