Healthcare Provider Details

I. General information

NPI: 1689538951
Provider Name (Legal Business Name): SUSAN ELIZABETH REICHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 WILSON RD
CENTRAL SQUARE NY
13036
US

IV. Provider business mailing address

633 COUNTY ROUTE 11
WEST MONROE NY
13167-3127
US

V. Phone/Fax

Practice location:
  • Phone: 315-439-1775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: