Healthcare Provider Details

I. General information

NPI: 1265802003
Provider Name (Legal Business Name): ERIC EID-REINER MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ERIC EID-REINER MSW, LICSW

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WILLOW ST STE B3A
SOUTH HAMILTON MA
01982-2253
US

IV. Provider business mailing address

123 HAVEN ST # 386
READING MA
01867-2952
US

V. Phone/Fax

Practice location:
  • Phone: 617-398-7066
  • Fax:
Mailing address:
  • Phone: 617-398-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121122
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number484992
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: