Healthcare Provider Details

I. General information

NPI: 1194005694
Provider Name (Legal Business Name): THOMAS JOSEPH REIS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

IV. Provider business mailing address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-5222
  • Fax: 508-676-5671
Mailing address:
  • Phone: 508-679-5222
  • Fax: 508-676-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120957
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier120957
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerINDEPENDENTLY LICENSED SOCIAL WORKER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: