Provider Demographics
NPI:1831987312
Name:REISS, CAROLINE (AMFT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:REISS
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 MONTECITO AVE
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5150
Mailing Address - Country:US
Mailing Address - Phone:805-338-9233
Mailing Address - Fax:
Practice Address - Street 1:2490 MONTECITO AVE
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-5150
Practice Address - Country:US
Practice Address - Phone:818-521-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152726106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist