Provider Demographics
NPI:1457891822
Name:REISS, NINA CHERYL
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:CHERYL
Last Name:REISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 JANET PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2818
Mailing Address - Country:US
Mailing Address - Phone:631-210-7508
Mailing Address - Fax:
Practice Address - Street 1:215 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3028
Practice Address - Country:US
Practice Address - Phone:631-210-7508
Practice Address - Fax:516-636-4342
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist