Healthcare Provider Details

I. General information

NPI: 1578851226
Provider Name (Legal Business Name): BRENDALI F REIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA REIS PH.D.

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 LEOPARD RD PAOLI EXECUTIVE GREEN II, SUITE 100
PAOLI PA
19301-1552
US

IV. Provider business mailing address

43 LEOPARD RD PAOLI EXECUTIVE GREEN II, SUITE 100
PAOLI PA
19301-1552
US

V. Phone/Fax

Practice location:
  • Phone: 610-945-8056
  • Fax:
Mailing address:
  • Phone: 610-945-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS009073L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: