Healthcare Provider Details

I. General information

NPI: 1124408661
Provider Name (Legal Business Name): JARED LEE REICHENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CENTERVILLE RD STE 105A
WARWICK RI
02886-4367
US

IV. Provider business mailing address

501 CENTERVILLE RD STE 105A
WARWICK RI
02886-4367
US

V. Phone/Fax

Practice location:
  • Phone: 401-300-0131
  • Fax:
Mailing address:
  • Phone: 401-300-0131
  • Fax: 401-326-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD16516
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: