=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336403856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARTNERS FOR CHANGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2012
-----------------------------------------------------
Last Update Date | 06/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4583 NORTH ST
-----------------------------------------------------
City | JAMESVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13078-9461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-254-8280
-----------------------------------------------------
Fax | 315-299-8671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4583 NORTH ST
-----------------------------------------------------
City | JAMESVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13078-9461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-254-8280
-----------------------------------------------------
Fax | 315-299-8671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMFT
-----------------------------------------------------
Name | DR. MARIA ANDREA REINKING
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 315-254-8280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000527
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------