Active NPI
Glenn Reeder, PSYD
- Clinical Child & Adolescent Psychologist
- York, PA
National Provider Identifier
1790727063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- PS005055L
- Practice address
- 3550 Concord Rd
York, PA 17402-8626 - Phone
- (717) 851-6340
- Fax
- (717) 851-6349
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | PS005055L | PA | Primary |
| Psychologist | 103T00000X | PS005055L | PA |
Addresses
Primary practice location
3550 Concord Rd
York, PA 17402-8626
Mailing address
1803 Mount Rose Ave
Ste B3
York, PA 17403-3026
Phone (717) 851-1405
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50000113 | Other | PA | CAPITAL BLUE CROSS |
| 284168 | Other | PA | MAMSI |
| 601092 | Other | PA | PA BLUE SHIELD |
| 227620000 | Other | PA | MAGELLAN |
| 687477 | Other | PA | BC/BS OF MD CARE FIRST |
| 125013 | Other | PA | VALUE OPTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS005055L | PA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328140800000",
"number": "1790727063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1803 MOUNT ROSE AVE",
"address_2": "STE B3",
"city": "YORK",
"state": "PA",
"postal_code": "174033026",
"telephone_number": "717-851-1405",
"fax_number": "717-851-6349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3550 CONCORD RD",
"city": "YORK",
"state": "PA",
"postal_code": "174028626",
"telephone_number": "717-851-6340",
"fax_number": "717-851-6349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REEDER",
"first_name": "GLENN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2012-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "PA",
"license": "PS005055L",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS005055L",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50000113",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "284168",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA BLUE SHIELD",
"identifier": "601092",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "227620000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MD CARE FIRST",
"identifier": "687477",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "125013",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in York, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.