Provider Demographics
NPI:1659382026
Name:REIMAN, BROCK MONROE (PHD)
Entity Type:Individual
Prefix:MR
First Name:BROCK
Middle Name:MONROE
Last Name:REIMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3309
Mailing Address - Country:US
Mailing Address - Phone:330-456-9214
Mailing Address - Fax:330-456-9251
Practice Address - Street 1:2705 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3309
Practice Address - Country:US
Practice Address - Phone:330-456-9214
Practice Address - Fax:330-456-9251
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH944019101YA0400X
OHE2094101YP2500X
OH5944103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRECP29232Medicare ID - Type UnspecifiedPROVIDER NUMBER