Provider Demographics
NPI:1629121751
Name:REICH, FAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FAY
Middle Name:
Last Name:REICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EDISON AVE
Mailing Address - Street 2:#2
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5829
Mailing Address - Country:US
Mailing Address - Phone:781-391-0780
Mailing Address - Fax:
Practice Address - Street 1:21 EDISON AVE
Practice Address - Street 2:#2
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5829
Practice Address - Country:US
Practice Address - Phone:781-391-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7360103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0526819Medicaid
MAW50286Medicare ID - Type Unspecified