Provider Demographics
NPI:1699826818
Name:REITER, TERRI LYNNE HEWETT (LCSW, LADC)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNNE HEWETT
Last Name:REITER
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HOVEY LUCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:ME
Mailing Address - Zip Code:04352-3319
Mailing Address - Country:US
Mailing Address - Phone:207-831-8690
Mailing Address - Fax:207-293-2310
Practice Address - Street 1:338 WATER ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1510
Practice Address - Country:US
Practice Address - Phone:207-831-8690
Practice Address - Fax:207-293-2310
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 3422101YA0400X
MELC 70931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098204OtherANTHEM PROVIDER NUMBER
ME11559226OtherCAQH CREDENTIALING NUMBER
MEME1292Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER