Healthcare Provider Details

I. General information

NPI: 1265916613
Provider Name (Legal Business Name): ERICA REIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 2ND ST
HACKENSACK NJ
07601-2009
US

IV. Provider business mailing address

12 2ND ST
HACKENSACK NJ
07601-2009
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00721800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: