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NPI Code Detail

MEDICARE: DR. MICHAEL LEE REISON PH.D., MSW, LICSW

MEDICARE: DR. MICHAEL LEE REISON PH.D., MSW, LICSW
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
11041C0700XClinical Social Worker104456MA

General Provider Information

NPI Number : 1730227836
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL LEE REISON PH.D., MSW, LICSW
Provider Business Mailing Address
First Line : 226 MASSACHUSETTS AVE
Second Line :
City : ARLINGTON
State : MA
Zip : 02474-8435
Country : US
Telephone Number : 781-643-8900
Fax Number : 781-643-8901
Provider Business Practice Location Address
First Line : 226 MASSACHUSETTS AVE
Second Line :
City : ARLINGTON
State : MA
Zip : 02474-8435
Country : US
Telephone Number : 781-643-8900
Fax Number : 781-643-8901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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