Provider Demographics
NPI:1730405218
Name:POWELL, REGINALD LESTER (LMFT)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:LESTER
Last Name:POWELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:REGGIE
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:19 JAY STREET
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553
Mailing Address - Country:US
Mailing Address - Phone:845-562-9816
Mailing Address - Fax:845-863-0351
Practice Address - Street 1:3250 US ROUTE 9W
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:845-562-9816
Practice Address - Fax:845-863-0351
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY001703-01106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor