MEDICARE: DR. EMILY REISS BISIGNANO

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	103T00000X	Psychologist	36832	TX
2	103TC2200X	Clinical Child & Adolescent Psychologist	36832	TX
3	103TF0000X	Family Psychologist	36832	TX
4	103TP2701X	Group Psychotherapy Psychologist	36832	TX
5	103TC0700X	Clinical Psychologist	36832	TX

General Provider Information

NPI Number	:	1871726141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY REISS BISIGNANO

Provider Business Mailing Address
First Line	:	13101 PRESTON RD STE 504
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-5231
Country	:	US
Telephone Number	:	469-248-5445
Fax Number	:

Provider Business Practice Location Address
First Line	:	13101 PRESTON RD
Second Line	:	SUITE 504
City	:	DALLAS
State	:	TX
Zip	:	75240-5237
Country	:	US
Telephone Number	:	469-248-5445
Fax Number	:

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	02/14/2018

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