Provider Demographics
NPI:1851890297
Name:REISINGER, SCOTT EDWARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:REISINGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-960-3954
Mailing Address - Fax:440-960-3956
Practice Address - Street 1:3600 KOLBE RD STE 120
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-960-3954
Practice Address - Fax:440-960-3956
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0381878Medicaid