MEDICARE: BRENDA REITER LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	20486	MD

General Provider Information

NPI Number	:	1396142659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA REITER LCSW-C

Provider Business Mailing Address
First Line	:	3565 ELLICOTT MILLS DR STE C2
Second Line	:	SUITE 206
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4549
Country	:	US
Telephone Number	:	410-409-0486
Fax Number	:

Provider Business Practice Location Address
First Line	:	3565 ELLICOTT MILLS DR STE C2
Second Line	:	SUITE 206
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4549
Country	:	US
Telephone Number	:	410-409-0486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	07/13/2015

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Directions to “ BRENDA REITER LCSW-C” Practice Location

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