Basic Information
| Provider Information | |||||||||
| NPI: | 1649713512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REUTER | ||||||||
| FirstName: | NIDYA | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 256 WASHINGTON ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105531052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149203750 | ||||||||
| FaxNumber: | 9146648189 | ||||||||
| Practice Location | |||||||||
| Address1: | 256 WASHINGTON ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105531052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149203750 | ||||||||
| FaxNumber: | 9146648189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2016 | ||||||||
| LastUpdateDate: | 11/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.