Healthcare Provider Details

I. General information

NPI: 1427263425
Provider Name (Legal Business Name): JUDITH ANN REIN PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 NEWPORT DR
INDIANA PA
15701-2418
US

IV. Provider business mailing address

PO BOX 2016 128 NEWPORT DRIVE
INDIANA PA
15701-5516
US

V. Phone/Fax

Practice location:
  • Phone: 724-464-2252
  • Fax: 724-463-1174
Mailing address:
  • Phone: 724-464-2252
  • Fax: 724-463-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007397L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS007397L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS007397L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPS007397L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS007397L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: