MEDICARE: MRS. SANDRA E REINERT L.C.S.W.-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R056708	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111029	OTHER	NY	VYTRA
2	R056708	OTHER	NY	HIP

General Provider Information

NPI Number	:	1437238755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA E REINERT L.C.S.W.-R

Provider Business Mailing Address
First Line	:	77 SEQUAMS LN E
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-4507
Country	:	US
Telephone Number	:	631-422-3685
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 SEQUAMS LN E
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-4507
Country	:	US
Telephone Number	:	631-422-3685
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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