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General NPI Number Information
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NPI Number | 1871692772
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Entity Type | Individual
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Provider Name | ANDREW DOUGLAS REISNER PSY. D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 66737 OLD TWENTY ONE RD
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City | CAMBRIDGE
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State | OH
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Zip | 43725-8987
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Country | US
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Telephone | 740-439-1371
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Fax | 740-432-1954
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Provider Business Mailing Address
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Address Line | 66737 OLD TWENTY ONE RD
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City | CAMBRIDGE
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State | OH
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Zip | 43725-8987
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Country | US
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Telephone | 740-439-1371
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Fax | 740-432-1954
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4109
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License Number State | OH
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