Provider Demographics
NPI:1093238214
Name:BAHL, JOANNA REITER
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:REITER
Last Name:BAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 PALOS VERDES DR N
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1157
Mailing Address - Country:US
Mailing Address - Phone:310-971-7385
Mailing Address - Fax:
Practice Address - Street 1:440 REDONDO AVE STE 103
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-5143
Practice Address - Country:US
Practice Address - Phone:310-800-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical