Provider Demographics
NPI:1427144906
Name:REICHBAUM, LEE STUART (PHD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:STUART
Last Name:REICHBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 FREEPORT ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238
Mailing Address - Country:US
Mailing Address - Phone:412-967-0610
Mailing Address - Fax:412-968-0527
Practice Address - Street 1:1326 FREEPORT ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238
Practice Address - Country:US
Practice Address - Phone:412-967-0610
Practice Address - Fax:412-968-0527
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006834L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023227OtherHIGHMARK BCBS
PA0016570560003Medicaid
PA0016570560003Medicaid