Provider Demographics
NPI:1659641314
Name:REEDY, COLLEN R (MA, LCMFT)
Entity Type:Individual
Prefix:MR
First Name:COLLEN
Middle Name:R
Last Name:REEDY
Suffix:
Gender:M
Credentials:MA, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 1ST ST NW
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1018
Mailing Address - Country:US
Mailing Address - Phone:443-602-1810
Mailing Address - Fax:
Practice Address - Street 1:2300 1ST ST NW
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1018
Practice Address - Country:US
Practice Address - Phone:443-602-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist