MEDICARE: DR. ABBY RUSSIN REESE PH.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	103TC0700X	Clinical Psychologist	017157	NY
2	103T00000X	Psychologist	PS016373	PA

General Provider Information

NPI Number	:	1972704419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABBY RUSSIN REESE PH.D.

Provider Business Mailing Address
First Line	:	1516 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4225
Country	:	US
Telephone Number	:	570-287-5200
Fax Number	:	570-609-1551

Provider Business Practice Location Address
First Line	:	1516 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4225
Country	:	US
Telephone Number	:	570-287-5200
Fax Number	:	570-609-1551

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	12/30/2021

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