Provider Demographics
NPI:1528296985
Name:OQUENDO, REINALDO (LCSW)
Entity type:Individual
Prefix:MR
First Name:REINALDO
Middle Name:
Last Name:OQUENDO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WETHERSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1113
Mailing Address - Country:US
Mailing Address - Phone:860-296-0094
Mailing Address - Fax:860-206-1184
Practice Address - Street 1:210 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1113
Practice Address - Country:US
Practice Address - Phone:860-296-0094
Practice Address - Fax:860-206-1184
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001483104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker