Provider Demographics
NPI:1366656159
Name:REYNOLDS, KATHLEEN WALSH (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:WALSH
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:33 POTVIN AVE
Mailing Address - Street 2:
Mailing Address - City:MOOSUP
Mailing Address - State:CT
Mailing Address - Zip Code:06354-1227
Mailing Address - Country:US
Mailing Address - Phone:203-901-6055
Mailing Address - Fax:
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:BEHAVIORAL HEALTH - COMMUNITY SVCS BLDG
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-963-6385
Practice Address - Fax:860-963-6393
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003150364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult