Provider Demographics
NPI:1891749529
Name:REYNOLDS, EMILY W (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:W
Last Name:REYNOLDS
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 1:19 HALLS RD STE 212
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1457
Mailing Address - Country:US
Mailing Address - Phone:860-876-7488
Mailing Address - Fax:860-661-4230
Practice Address - Street 1:19 HALLS RD STE 212
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1457
Practice Address - Country:US
Practice Address - Phone:860-876-7488
Practice Address - Fax:860-443-4284
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001498101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional