Provider Demographics
NPI:1962894899
Name:REAVEY, PETER (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:REAVEY
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:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-0502
Mailing Address - Country:US
Mailing Address - Phone:732-418-8729
Mailing Address - Fax:
Practice Address - Street 1:482 SPRINGFIELD AVE # 210
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2601
Practice Address - Country:US
Practice Address - Phone:908-273-5558
Practice Address - Fax:908-273-3355
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100664500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist