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General NPI Number Information
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NPI Number | 1942833157
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Entity Type | Individual
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Provider Name | HEATHER REIS LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/16/2020
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 401 STOCKBRIDGE RD
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City | GREAT BARRINGTON
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State | MA
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Zip | 01230-1972
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Country | US
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Telephone | 413-347-9103
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | HOUSATONIC
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State | MA
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Zip | 01236-0250
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Country | US
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Telephone | 413-329-0736
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 000123931
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License Number State | MA
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