Provider Demographics
NPI:1689618381
Name:REINHARDT, MARA II (PSYD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:REINHARDT
Suffix:II
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 1:100 PINEWOOD RD
Mailing Address - Street 2:APT. 1A
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1676
Mailing Address - Country:US
Mailing Address - Phone:646-528-6429
Mailing Address - Fax:914-422-5724
Practice Address - Street 1:441 WEST END AVENUE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:646-528-6429
Practice Address - Fax:914-422-5724
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013579103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02053381Medicaid
NYVS0051Medicare ID - Type Unspecified