Healthcare Provider Details

I. General information

NPI: 1336343169
Provider Name (Legal Business Name): ROBERT C REDA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 34TH ST 11TH FLOOR
NEW YORK NY
10001-2320
US

IV. Provider business mailing address

12 MANOR HOUSE DR G17
DOBBS FERRY NY
10522-2523
US

V. Phone/Fax

Practice location:
  • Phone: 347-547-7211
  • Fax: 347-547-7197
Mailing address:
  • Phone: 914-674-4293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079108-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: