Provider Demographics
NPI:1932307543
Name:REICHENBERG, RAYMOND MARK (PSYCHOANALYST)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:MARK
Last Name:REICHENBERG
Suffix:
Gender:M
Credentials:PSYCHOANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1374
Mailing Address - Country:US
Mailing Address - Phone:917-627-6047
Mailing Address - Fax:
Practice Address - Street 1:808 UNION ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1374
Practice Address - Country:US
Practice Address - Phone:917-627-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19000413102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst