Provider Demographics
NPI:1427453547
Name:REICHERT, MALLORY (LCSW)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:REICHERT
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 KINGS HWY N STE 650
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1931
Mailing Address - Country:US
Mailing Address - Phone:856-297-1411
Mailing Address - Fax:
Practice Address - Street 1:1101 KINGS HWY N STE 103
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1912
Practice Address - Country:US
Practice Address - Phone:856-297-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055990001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical