MEDICARE: DR. NATALIE REISS PH.D.

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	103TC0700X	Clinical Psychologist	6083	OH

General Provider Information

NPI Number	:	1659781052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE REISS PH.D.

Provider Business Mailing Address
First Line	:	2645 LEE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-4109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12429 CEDAR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3199
Country	:	US
Telephone Number	:	216-632-1493
Fax Number	:

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

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	05/07/2014

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