Healthcare Provider Details

I. General information

NPI: 1013882836
Provider Name (Legal Business Name): JEFF REISER REISER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8908 RIGGS RD
ADELPHI MD
20783-1632
US

IV. Provider business mailing address

9528 RILEY RD
SILVER SPRING MD
20910-1374
US

V. Phone/Fax

Practice location:
  • Phone: 301-431-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: