Provider Demographics
NPI:1285038729
Name:REISBERG, JENNIFER (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REISBERG
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 E MADISON ST
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4749
Mailing Address - Country:US
Mailing Address - Phone:206-486-0107
Mailing Address - Fax:
Practice Address - Street 1:2711 E MADISON ST
Practice Address - Street 2:SUITE 204A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4749
Practice Address - Country:US
Practice Address - Phone:206-486-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60613549101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program