Provider Demographics
NPI:1336343169
Name:REDA, ROBERT C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:REDA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 MANOR HOUSE DR
Mailing Address - Street 2:G17
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2523
Mailing Address - Country:US
Mailing Address - Phone:914-674-4293
Mailing Address - Fax:
Practice Address - Street 1:460 W 34TH ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2320
Practice Address - Country:US
Practice Address - Phone:347-547-7211
Practice Address - Fax:347-547-7197
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY079108-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY072839OtherLICENSE NUMBER