Provider Demographics
NPI:1578851226
Name:REIS, BRENDALI F (PHD)
Entity Type:Individual
Prefix:
First Name:BRENDALI
Middle Name:F
Last Name:REIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:REIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:43 LEOPARD RD
Mailing Address - Street 2:PAOLI EXECUTIVE GREEN II, SUITE 100
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1552
Mailing Address - Country:US
Mailing Address - Phone:610-945-8056
Mailing Address - Fax:
Practice Address - Street 1:43 LEOPARD RD
Practice Address - Street 2:PAOLI EXECUTIVE GREEN II, SUITE 100
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1552
Practice Address - Country:US
Practice Address - Phone:610-945-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009073L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical