Provider Demographics
NPI:1841930328
Name:BROOKSIDE PSYCHIATRIC SPECIALISTS PLLC
Entity type:Organization
Organization Name:BROOKSIDE PSYCHIATRIC SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHENBACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:319-359-3810
Mailing Address - Street 1:2624 SOUTHERN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7433
Mailing Address - Country:US
Mailing Address - Phone:757-453-1256
Mailing Address - Fax:319-359-3813
Practice Address - Street 1:2624 SOUTHERN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7433
Practice Address - Country:US
Practice Address - Phone:757-453-1256
Practice Address - Fax:319-359-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty