Provider Demographics
NPI:1457448870
Name:REITER, CARL DANIEL JR (LCSW-R)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:DANIEL
Last Name:REITER
Suffix:JR
Gender:M
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 1:2650 WICKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-1617
Mailing Address - Country:US
Mailing Address - Phone:631-298-5141
Mailing Address - Fax:
Practice Address - Street 1:300 CENTER DR
Practice Address - Street 2:COUNTY CENTER BLDG.
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3393
Practice Address - Country:US
Practice Address - Phone:631-852-1440
Practice Address - Fax:631-852-1448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR014623-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN48382Medicare ID - Type Unspecified