Provider Demographics
NPI:1619602638
Name:REYNOLDS-MUNDELL, KERRICE
Entity Type:Individual
Prefix:
First Name:KERRICE
Middle Name:
Last Name:REYNOLDS-MUNDELL
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 1:102 WYLLYS ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2727
Mailing Address - Country:US
Mailing Address - Phone:860-335-3757
Mailing Address - Fax:
Practice Address - Street 1:102 WYLLYS ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2727
Practice Address - Country:US
Practice Address - Phone:860-335-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health