Provider Demographics
NPI:1598806507
Name:HAWKINS, REYNOLDS EUGENE JR (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:REYNOLDS
Middle Name:EUGENE
Last Name:HAWKINS
Suffix:JR
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-1501
Mailing Address - Country:US
Mailing Address - Phone:631-851-9107
Mailing Address - Fax:631-851-9456
Practice Address - Street 1:55 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-1501
Practice Address - Country:US
Practice Address - Phone:631-851-9107
Practice Address - Fax:631-851-9456
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health