Provider Demographics
NPI:1790727063
Name:REEDER, GLENN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:REEDER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:STE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005055L103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50000113OtherCAPITAL BLUE CROSS
PA284168OtherMAMSI
PA601092OtherPA BLUE SHIELD
PA227620000OtherMAGELLAN
PA687477OtherBC/BS OF MD CARE FIRST
PA125013OtherVALUE OPTIONS
PA687477OtherBC/BS OF MD CARE FIRST