Provider Demographics
NPI:1689966210
Name:REICHARD, RANDI JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:JO
Last Name:REICHARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:LANSE
Mailing Address - State:PA
Mailing Address - Zip Code:16849-0040
Mailing Address - Country:US
Mailing Address - Phone:814-577-0128
Mailing Address - Fax:
Practice Address - Street 1:2018 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:MORRISDALE
Practice Address - State:PA
Practice Address - Zip Code:16858
Practice Address - Country:US
Practice Address - Phone:814-577-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0181391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty