=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285744706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH EDWARD REINHARD PHD,ABPP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2094 ALBANY POST RD RM. 133D
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10548-1454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-737-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 DAILEY DR
-----------------------------------------------------
City | CROTON ON HUDSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10520-3536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-271-3336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 007093
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------