Provider Demographics
NPI:1144316050
Name:REITKNECHT, DESIREE BEVERLY (MFT)
Entity type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:BEVERLY
Last Name:REITKNECHT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TURNER CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3426
Mailing Address - Country:US
Mailing Address - Phone:415-596-8875
Mailing Address - Fax:
Practice Address - Street 1:15 TURNER COURT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3507
Practice Address - Country:US
Practice Address - Phone:415-596-8875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43777106H00000X
NJ37FI00176400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist