1396882817 NPI number — WENDY SUE REICH L.I.C.S.W.

Table of content: WENDY SUE REICH L.I.C.S.W. (NPI 1396882817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396882817 NPI number — WENDY SUE REICH L.I.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REICH
Provider First Name:
WENDY
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.I.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396882817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 RUNNING BROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ROXBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02132-4754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-327-5770
Provider Business Mailing Address Fax Number:
800-293-5581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 RUNNING BROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST ROXBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02132-4754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-327-5770
Provider Business Practice Location Address Fax Number:
800-293-5581
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW 1016194-1 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1811651 . This is a "MBHP PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 765531 . This is a "TUFTS PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 190878 . This is a "COMP PSYCH ROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 550010004866 . This is a "PACIFICARE PROVIDER NUMBE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1851659 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PR-3234726-0001 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 70010000-P04736 . This is a "BLUE CROSS BLUE SHIELD NO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: SW1016194-1 . This is a "SOCIAL WORK LICENSE NUMBE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 152865 . This is a "MAGELLAN PROVIDER NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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