Provider Demographics
NPI:1043313620
Name:REICHWALD, NORMAN D (PSYD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:D
Last Name:REICHWALD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 930
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1438
Mailing Address - Country:US
Mailing Address - Phone:213-739-0019
Mailing Address - Fax:213-739-0091
Practice Address - Street 1:1206 E 17TH STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2641
Practice Address - Country:US
Practice Address - Phone:714-210-8848
Practice Address - Fax:714-210-8856
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19287103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist