Healthcare Provider Details

I. General information

NPI: 1801610498
Provider Name (Legal Business Name): ALEXIS REISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ROUTE 34 STE 106
COLTS NECK NJ
07722-2444
US

IV. Provider business mailing address

64 DANELLA WAY
HOWELL NJ
07731-8917
US

V. Phone/Fax

Practice location:
  • Phone: 732-648-6423
  • Fax:
Mailing address:
  • Phone: 732-618-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00839200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: