Provider Demographics
NPI:1699582601
Name:REINDEAU, SAMANTHA (LDT-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:REINDEAU
Suffix:
Gender:F
Credentials:LDT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37-01 FERRY HTS
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4364
Mailing Address - Country:US
Mailing Address - Phone:201-703-8429
Mailing Address - Fax:
Practice Address - Street 1:18 E CAMDEN ST UNIT 338
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7552
Practice Address - Country:US
Practice Address - Phone:973-910-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01698968251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health