Provider Demographics
NPI:1396747317
Name:REITER, RICHARD MARTIN (LCSW)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARTIN
Last Name:REITER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5791 COACH HOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-8641
Mailing Address - Country:US
Mailing Address - Phone:561-417-5702
Mailing Address - Fax:561-392-3847
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:STE 312
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-394-9492
Practice Address - Fax:561-392-3847
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-73851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4807Medicare ID - Type Unspecified