Provider Demographics
NPI:1528753670
Name:REIMER, KENNETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:REIMER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12903 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5138
Mailing Address - Country:US
Mailing Address - Phone:301-965-0427
Mailing Address - Fax:
Practice Address - Street 1:7825 TUCKERMAN LN STE 209
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3241
Practice Address - Country:US
Practice Address - Phone:301-965-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06891103TM1800X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06891OtherLICENSED PSYCHOLOGIST