Healthcare Provider Details

I. General information

NPI: 1932307543
Provider Name (Legal Business Name): RAYMOND MARK REICHENBERG PSYCHOANALYST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 UNION ST
BROOKLYN NY
11215-1374
US

IV. Provider business mailing address

808 UNION ST
BROOKLYN NY
11215-1374
US

V. Phone/Fax

Practice location:
  • Phone: 917-627-6047
  • Fax:
Mailing address:
  • Phone: 917-627-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number19000413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: