Healthcare Provider Details

I. General information

NPI: 1609816529
Provider Name (Legal Business Name): JOHN A REINHARDT PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HICKORY ST
SCRANTON PA
18505-1165
US

IV. Provider business mailing address

110 SHORE RD
TAFTON PA
18464-7704
US

V. Phone/Fax

Practice location:
  • Phone: 570-470-4174
  • Fax: 570-702-8575
Mailing address:
  • Phone: 570-470-4174
  • Fax: 570-702-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS003830L
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: