Provider Demographics
NPI:1437238755
Name:REINERT, SANDRA E (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:E
Last Name:REINERT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SEQUAMS LN E
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4507
Mailing Address - Country:US
Mailing Address - Phone:631-422-3685
Mailing Address - Fax:
Practice Address - Street 1:77 SEQUAMS LN E
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4507
Practice Address - Country:US
Practice Address - Phone:631-422-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0567081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY111029OtherVYTRA
NYR056708OtherHIP
NYN17B2Medicare ID - Type Unspecified