Provider Demographics
NPI:1780818690
Name:REITENAUER, ANDREW LEE (MA, MATS, BCPC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LEE
Last Name:REITENAUER
Suffix:
Gender:M
Credentials:MA, MATS, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2017
Mailing Address - Country:US
Mailing Address - Phone:610-866-1388
Mailing Address - Fax:
Practice Address - Street 1:1414 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2017
Practice Address - Country:US
Practice Address - Phone:610-866-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X, 101YP1600X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral