Provider Demographics
NPI:1184701393
Name:REED, JOHN HOWE SR (MS LADC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HOWE
Last Name:REED
Suffix:SR
Gender:M
Credentials:MS LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 EXETER RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249-1544
Mailing Address - Country:US
Mailing Address - Phone:860-303-9540
Mailing Address - Fax:860-642-9944
Practice Address - Street 1:525 EXETER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:CT
Practice Address - Zip Code:06249-1544
Practice Address - Country:US
Practice Address - Phone:860-303-9540
Practice Address - Fax:860-642-9944
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000611101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00000611CT03OtherANTHEM PIN
CT000611OtherDEPT OF HEALTH LIC #