Healthcare Provider Details

I. General information

NPI: 1982249082
Provider Name (Legal Business Name): REISA F VILLANI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REISA BERG

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 MAIN ST
COLD SPRING HARBOR NY
11724-1425
US

IV. Provider business mailing address

147 MAIN ST
COLD SPRING HARBOR NY
11724-1425
US

V. Phone/Fax

Practice location:
  • Phone: 631-745-7306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088677-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: