Provider Demographics
NPI:1114286457
Name:REIMER, MARYKATE
Entity Type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:REIMER
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 1:4 BARLOWS LANDING RD STE 13
Mailing Address - Street 2:4 BARLOWS LANDINF ROAD SUITE 13
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-1984
Mailing Address - Country:US
Mailing Address - Phone:508-563-5767
Mailing Address - Fax:508-563-5774
Practice Address - Street 1:4 BARLOWS LANDING RD STE 13
Practice Address - Street 2:4 BARLOWS LANDINF RD SUITE 13
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-1984
Practice Address - Country:US
Practice Address - Phone:508-563-5767
Practice Address - Fax:508-563-5774
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS58024980103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst