MEDICARE: DR. ELISA DORI REICH PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC0700X	Clinical Psychologist	26123	CA

General Provider Information

NPI Number	:	1033422068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISA DORI REICH PSY.D.

Provider Business Mailing Address
First Line	:	11965 VENICE BLVD
Second Line	:	SUITE 202
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3979
Country	:	US
Telephone Number	:	888-724-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	11965 VENICE BLVD
Second Line	:	SUITE 202
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3979
Country	:	US
Telephone Number	:	888-724-0040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	01/31/2014

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