Healthcare Provider Details

I. General information

NPI: 1659599942
Provider Name (Legal Business Name): KEVIN C REIS ED.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 SCHOOLHOUSE RD
STUYVESANT NY
12173-1803
US

IV. Provider business mailing address

199 SCHOOLHOUSE RD
STUYVESANT NY
12173-1803
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-2738
  • Fax: 518-325-4111
Mailing address:
  • Phone: 518-758-2738
  • Fax: 518-325-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number831
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: