Provider Demographics
NPI:1508972399
Name:POWELL-REEVES, PAULETTE IRIS (LPC)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:IRIS
Last Name:POWELL-REEVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6646
Mailing Address - Country:US
Mailing Address - Phone:203-258-8213
Mailing Address - Fax:
Practice Address - Street 1:2874 MAIN ST
Practice Address - Street 2:SUITE 2 E, SECOND FLOOR
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4957
Practice Address - Country:US
Practice Address - Phone:203-540-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
11582512OtherCAQH ID
CT240001455CT01OtherBLUE CROSS/BLUE SHIELD