Provider Demographics
NPI:1164464855
Name:REIBER, VIRGINIA D (PHD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:D
Last Name:REIBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HIGH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1854
Mailing Address - Country:US
Mailing Address - Phone:781-352-0930
Mailing Address - Fax:781-329-1183
Practice Address - Street 1:601 HIGH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1854
Practice Address - Country:US
Practice Address - Phone:781-352-0930
Practice Address - Fax:781-329-1183
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W50069Medicare PIN