Provider Demographics
NPI:1538870936
Name:SMITH, REGINALD LLWELLYN JR
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:LLWELLYN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 STANTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-4040
Mailing Address - Country:US
Mailing Address - Phone:863-241-3032
Mailing Address - Fax:
Practice Address - Street 1:44 STANTON ST APT 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-4040
Practice Address - Country:US
Practice Address - Phone:863-241-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor