Provider Demographics
NPI:1679293039
Name:REUSCHER, GARRETT YELLEN (LMSW)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:YELLEN
Last Name:REUSCHER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 EVERGREEN AVE APT 117
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6629
Mailing Address - Country:US
Mailing Address - Phone:207-317-0281
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE RM 306
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5075
Practice Address - Country:US
Practice Address - Phone:212-337-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111534104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker