MEDICARE: MS. ANNE ELIZABETH REISMAN L.C.S.W.

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	101YM0800X	Mental Health Counselor	LCS13433	CA

General Provider Information

NPI Number	:	1225110158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE ELIZABETH REISMAN L.C.S.W.

Provider Business Mailing Address
First Line	:	458 S. CRESCENT DRIVE
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212
Country	:	US
Telephone Number	:	310-552-9756
Fax Number	:	310-552-9756

Provider Business Practice Location Address
First Line	:	458 S CRESCENT DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4506
Country	:	US
Telephone Number	:	310-552-9756
Fax Number	:	310-552-9756

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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