Healthcare Provider Details

I. General information

NPI: 1790520963
Provider Name (Legal Business Name): KIMBERLY REITENAUER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CONRAD RD
ALBURTIS PA
18011-2015
US

IV. Provider business mailing address

231 CONRAD RD
ALBURTIS PA
18011-2015
US

V. Phone/Fax

Practice location:
  • Phone: 484-709-0767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW025835
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: