Healthcare Provider Details

I. General information

NPI: 1013301852
Provider Name (Legal Business Name): ABIGAIL L REIDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 DANA AVE
PALO ALTO CA
94303-2813
US

IV. Provider business mailing address

1536 DANA AVE
PALO ALTO CA
94303-2813
US

V. Phone/Fax

Practice location:
  • Phone: 203-645-6062
  • Fax:
Mailing address:
  • Phone: 203-645-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: