Provider Demographics
NPI:1316105901
Name:REIDY, M. BERNADETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:M. BERNADETTE
Middle Name:
Last Name:REIDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3825
Mailing Address - Country:US
Mailing Address - Phone:585-248-3997
Mailing Address - Fax:866-810-2824
Practice Address - Street 1:37 FRENCH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3825
Practice Address - Country:US
Practice Address - Phone:585-248-3997
Practice Address - Fax:866-810-2824
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009225103TC0700X, 103TC2200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11848344OtherCAQH