Provider Demographics
NPI:1356535850
Name:REYNOLDS, MICHELLE MONACO (PHD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MONACO
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-1410
Mailing Address - Country:US
Mailing Address - Phone:203-376-8284
Mailing Address - Fax:203-204-1381
Practice Address - Street 1:11 WOODLAND RD STE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2380
Practice Address - Country:US
Practice Address - Phone:203-208-8996
Practice Address - Fax:203-204-1381
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical