Provider Demographics
NPI:1164005658
Name:REICHENBACH, EVANN LYNNE (LMSW)
Entity Type:Individual
Prefix:
First Name:EVANN
Middle Name:LYNNE
Last Name:REICHENBACH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 COULSON DR
Mailing Address - Street 2:
Mailing Address - City:COLORA
Mailing Address - State:MD
Mailing Address - Zip Code:21917-1232
Mailing Address - Country:US
Mailing Address - Phone:443-350-4667
Mailing Address - Fax:
Practice Address - Street 1:23 COULSON DR
Practice Address - Street 2:
Practice Address - City:COLORA
Practice Address - State:MD
Practice Address - Zip Code:21917-1232
Practice Address - Country:US
Practice Address - Phone:443-350-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical