Healthcare Provider Details

I. General information

NPI: 1003040015
Provider Name (Legal Business Name): SALLY E REEVES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 PENN AVENUE
READING PA
19609-2054
US

IV. Provider business mailing address

207 7TH STREET
LEBANON PA
17046-5040
US

V. Phone/Fax

Practice location:
  • Phone: 610-670-9923
  • Fax: 610-670-2587
Mailing address:
  • Phone: 717-273-1710
  • Fax: 717-273-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009333
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: