Provider Demographics
NPI:1881806974
Name:REICHARDT, DENNIS (PHD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:REICHARDT
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 1:46 SPAULDINGS BAY CT
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6455
Mailing Address - Country:US
Mailing Address - Phone:802-862-6753
Mailing Address - Fax:802-862-6753
Practice Address - Street 1:46 SPAULDINGS BAY CT
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6455
Practice Address - Country:US
Practice Address - Phone:802-862-6753
Practice Address - Fax:802-862-6753
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical