Healthcare Provider Details

I. General information

NPI: 1922170497
Provider Name (Legal Business Name): MARGARET REISS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 TELEGRAPH AVE
BERKELEY CA
94705-1117
US

IV. Provider business mailing address

2714 TELEGRAPH AVE
BERKELEY CA
94705-1117
US

V. Phone/Fax

Practice location:
  • Phone: 510-649-1273
  • Fax:
Mailing address:
  • Phone: 510-649-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS4541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: