Provider Demographics
NPI:1538114939
Name:REITER, MICHELE (MS, LICSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:REITER
Suffix:
Gender:F
Credentials:MS, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TRUMBULL RD
Mailing Address - Street 2:#102
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3079
Mailing Address - Country:US
Mailing Address - Phone:413-586-1383
Mailing Address - Fax:413-772-3524
Practice Address - Street 1:8 TRUMBULL RD
Practice Address - Street 2:#102
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3079
Practice Address - Country:US
Practice Address - Phone:413-586-1383
Practice Address - Fax:413-772-3524
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1007581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARE P02606Medicare ID - Type Unspecified