Healthcare Provider Details

I. General information

NPI: 1629950050
Provider Name (Legal Business Name): BENNETT ADAMS REISS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

IV. Provider business mailing address

6332 ENTRADA DE MILAGRO APT 523
SANTA FE NM
87507-1647
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-4985
  • Fax:
Mailing address:
  • Phone: 516-713-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: