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General NPI Number Information
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NPI Number | 1659567030
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Entity Type | Individual
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Provider Name | MARYANN REUTER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 9600 CENTER AVE STE 160
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5838
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Country | US
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Telephone | 708-740-7241
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Fax |
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Provider Business Mailing Address
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Address Line | 16255 VENTURA BLVD STE 830
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City | ENCINO
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State | CA
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Zip | 91436-2317
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Country | US
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Telephone | 704-780-4271
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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 | PSY24360
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License Number State | CA
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