Provider Demographics
NPI:1760599534
Name:REICHERT, LOUIS EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:EDWARD
Last Name:REICHERT
Suffix:
Gender:M
Credentials:PHD
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 880627
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33488-0627
Mailing Address - Country:US
Mailing Address - Phone:561-988-9960
Mailing Address - Fax:561-988-9959
Practice Address - Street 1:9045 LA FONTANA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5641
Practice Address - Country:US
Practice Address - Phone:561-477-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002532103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
74330Medicare ID - Type Unspecified