Basic Information
Provider Information
NPI: 1922551571
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REICHMAN
FirstName: DEBORAH
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1745 BROADWAY
Address2: 17TH FL.
City: NEW YORK
State: NY
PostalCode: 100194640
CountryCode: US
TelephoneNumber: 2128518100
FaxNumber: 2125370102
Practice Location
Address1: 1745 BROADWAY
Address2: 17TH FL.
City: NEW YORK
State: NY
PostalCode: 100194640
CountryCode: US
TelephoneNumber: 2128518100
FaxNumber: 2125370102
Other Information
ProviderEnumerationDate: 08/01/2016
LastUpdateDate: 09/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X021688NYY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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