Provider Demographics
NPI:1609507557
Name:REISS, BASHIE (LCSW)
Entity Type:Individual
Prefix:
First Name:BASHIE
Middle Name:
Last Name:REISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ROSEBANK ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2059
Mailing Address - Country:US
Mailing Address - Phone:973-945-4565
Mailing Address - Fax:
Practice Address - Street 1:902 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2096
Practice Address - Country:US
Practice Address - Phone:732-945-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical