Provider Demographics
NPI:1932889037
Name:REYNA, AMBER (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:REYNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CRANBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5171
Mailing Address - Country:US
Mailing Address - Phone:860-538-8765
Mailing Address - Fax:
Practice Address - Street 1:180 CRANBERRY LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5171
Practice Address - Country:US
Practice Address - Phone:860-538-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT130941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical