Provider Demographics
NPI:1740488428
Name:REITER, MARTHA ANN
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:REITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 GREENWOOD PL
Mailing Address - Street 2:APT. 6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2699
Mailing Address - Country:US
Mailing Address - Phone:323-973-0105
Mailing Address - Fax:
Practice Address - Street 1:1172 TELEGRAPH RD.
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670
Practice Address - Country:US
Practice Address - Phone:562-801-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health