MEDICARE: BASHIE REISS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1609507557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASHIE REISS LCSW

Provider Business Mailing Address
First Line	:	132 ROSEBANK ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2059
Country	:	US
Telephone Number	:	973-945-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 E COUNTY LINE RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2096
Country	:	US
Telephone Number	:	732-945-4565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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Directions to “ BASHIE REISS LCSW” Practice Location

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