Provider Demographics
NPI:1629121280
Name:REISS, CATHERINE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARIE
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 1:12957 PALMS WEST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4989
Mailing Address - Country:US
Mailing Address - Phone:561-790-3750
Mailing Address - Fax:561-792-5874
Practice Address - Street 1:12957 PALMS WEST DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4989
Practice Address - Country:US
Practice Address - Phone:561-790-3750
Practice Address - Fax:561-792-5874
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL39031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z6617OtherBLUE CROSS&BLUE SHIELD
199660OtherMANAGED HEALTH NETWORK