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General NPI Number Information
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NPI Number | 1306926696
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Entity Type | Individual
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Provider Name | SANDRA M. REIKEN MSW, PHD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 14 ASHWOOD TRL
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City | BOONTON
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State | NJ
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Zip | 07005-8838
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Country | US
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Telephone | 973-714-6659
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Fax |
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Provider Business Mailing Address
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Address Line | 280 POWERVILLE RD
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City | BOONTON
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State | NJ
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Zip | 07005-9152
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Country | US
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Telephone | 973-402-4855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35S100282600
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License Number State | NJ
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