Provider Demographics
NPI:1750015426
Name:REICHENBERGER DE OLIVEIRA, MARINA PILAR ELIZABETH
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:PILAR ELIZABETH
Last Name:REICHENBERGER DE OLIVEIRA
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 1:3246 HIGHGATE CHASE CT
Mailing Address - Street 2:
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4958
Mailing Address - Country:US
Mailing Address - Phone:470-416-3175
Mailing Address - Fax:
Practice Address - Street 1:3246 HIGHGATE CHASE CT
Practice Address - Street 2:
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30092-4958
Practice Address - Country:US
Practice Address - Phone:470-416-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty