Provider Demographics
NPI:1811070360
Name:REA, CATHLEEN A (PHD)
Entity type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:A
Last Name:REA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12695 MCMANUS BLVD
Mailing Address - Street 2:BLDG #8
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4435
Mailing Address - Country:US
Mailing Address - Phone:757-877-7700
Mailing Address - Fax:757-872-7211
Practice Address - Street 1:12695 MCMANUS BLVD
Practice Address - Street 2:BLDG #8
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4435
Practice Address - Country:US
Practice Address - Phone:757-877-7700
Practice Address - Fax:757-872-7211
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810-001325103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA77-0279-5Medicaid