Provider Demographics
NPI:1356512644
Name:REITER, SHERRY L (PHD, MSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:REITER
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:REITER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, PHD
Mailing Address - Street 1:1904 EAST 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:718-998-4572
Mailing Address - Fax:
Practice Address - Street 1:2350 OCEAN AVE
Practice Address - Street 2:APT 2E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3043
Practice Address - Country:US
Practice Address - Phone:718-998-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCS03953411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN64161Medicare PIN