Healthcare Provider Details

I. General information

NPI: 1376119560
Provider Name (Legal Business Name): COURTNEY NICOLE REINHART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 SYCAMORE DR
SIMI VALLEY CA
93065-1201
US

IV. Provider business mailing address

PO BOX 1903
SIMI VALLEY CA
93062-1903
US

V. Phone/Fax

Practice location:
  • Phone: 805-955-6849
  • Fax:
Mailing address:
  • Phone: 805-433-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW100994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: