Provider Demographics
NPI:1871119412
Name:KRISTA REINCKE, PSY.D., LLC
Entity type:Organization
Organization Name:KRISTA REINCKE, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:MARIE DUFFY
Authorized Official - Last Name:REINCKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:802-735-7934
Mailing Address - Street 1:354 COLLAMER CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6444
Mailing Address - Country:US
Mailing Address - Phone:802-735-7934
Mailing Address - Fax:
Practice Address - Street 1:86 SAINT PAUL ST STE 307
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4958
Practice Address - Country:US
Practice Address - Phone:802-735-7934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty