Provider Demographics
NPI:1609816529
Name:REINHARDT, JOHN A (PH D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:REINHARDT
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:TAFTON
Mailing Address - State:PA
Mailing Address - Zip Code:18464-7704
Mailing Address - Country:US
Mailing Address - Phone:570-470-4174
Mailing Address - Fax:570-702-8575
Practice Address - Street 1:215 HICKORY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1165
Practice Address - Country:US
Practice Address - Phone:570-470-4174
Practice Address - Fax:570-702-8575
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003830L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical