MEDICARE: BROOKSIDE PSYCHIATRIC SPECIALISTS PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1841930328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKSIDE PSYCHIATRIC SPECIALISTS PLLC

Provider Business Mailing Address
First Line	:	2624 SOUTHERN BLVD STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7433
Country	:	US
Telephone Number	:	757-453-1256
Fax Number	:	319-359-3813

Provider Business Practice Location Address
First Line	:	2624 SOUTHERN BLVD STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7433
Country	:	US
Telephone Number	:	757-453-1256
Fax Number	:	319-359-3813

Authorized Official
Title or Position	:	OWNER, NURSE PRACTITIONER
Name	:	DR. OLIVIA REICHENBACKER
Credential	:	DNP, PMHNP-BC
Telephone Number	:	319-359-3810

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	02/07/2024

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