Provider Demographics
NPI:1790841625
Name:REISS, DEBRA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
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 1:76 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2837
Mailing Address - Country:US
Mailing Address - Phone:631-421-1669
Mailing Address - Fax:
Practice Address - Street 1:76 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2837
Practice Address - Country:US
Practice Address - Phone:631-421-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042010-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3495558OtherOXFORD HEALTH PLANS
NYN23241OtherEMPIRE BLUE CROSS BLUE SH
NYN23241Medicare ID - Type Unspecified