MEDICARE: DR. DANA REINECKE BCBA-D, LBA

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	103K00000X	Behavior Analyst	000078-1	NY
2	103T00000X	Psychologist	024078	NY

General Provider Information

NPI Number	:	1477001105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA REINECKE BCBA-D, LBA

Provider Business Mailing Address
First Line	:	611 W WALNUT ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2918
Country	:	US
Telephone Number	:	917-797-2701
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 W WALNUT ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2918
Country	:	US
Telephone Number	:	917-797-2701
Fax Number	:

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

Provider Enumeration Date	:	09/11/2016
Last Update Date	:	04/06/2021

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