Provider Demographics
NPI:1811062417
Name:REICHENBERG, EDWARD STEVEN (LCSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:STEVEN
Last Name:REICHENBERG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OAK LN
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2038
Mailing Address - Country:US
Mailing Address - Phone:908-272-4992
Mailing Address - Fax:
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:NINTH FLOOR, SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4709
Practice Address - Country:US
Practice Address - Phone:212-989-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR023356-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical