Provider Demographics
NPI:1306926696
Name:REIKEN, SANDRA M (MSW, PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:REIKEN
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 POWERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9152
Mailing Address - Country:US
Mailing Address - Phone:973-402-4855
Mailing Address - Fax:
Practice Address - Street 1:14 ASHWOOD TRL
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-8838
Practice Address - Country:US
Practice Address - Phone:973-714-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100282600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ891353Medicare ID - Type UnspecifiedMEDICARE