Provider Demographics
NPI:1710077128
Name:REIM, BRUCE E (MSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:E
Last Name:REIM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-1409
Mailing Address - Country:US
Mailing Address - Phone:609-466-0166
Mailing Address - Fax:609-466-0166
Practice Address - Street 1:204 HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-1409
Practice Address - Country:US
Practice Address - Phone:609-466-0166
Practice Address - Fax:609-466-0166
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00178700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
051775OtherVALUE OPTIONS
7328354OtherGHI