Provider Demographics
NPI:1063766954
Name:REITER, MATTHEW THEODORE (MAED)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:THEODORE
Last Name:REITER
Suffix:
Gender:M
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 WINDHAM CT
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5035
Mailing Address - Country:US
Mailing Address - Phone:330-726-9570
Mailing Address - Fax:
Practice Address - Street 1:955 WINDHAM CT
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5035
Practice Address - Country:US
Practice Address - Phone:330-726-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional