Provider Demographics
NPI:1528121233
Name:REISS, DOUGLAS J (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:REISS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N. CRAIG ST.
Mailing Address - Street 2:STE 209
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2758
Mailing Address - Country:US
Mailing Address - Phone:412-687-3842
Mailing Address - Fax:412-687-8212
Practice Address - Street 1:128 N. CRAIG ST.
Practice Address - Street 2:STE 209
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2758
Practice Address - Country:US
Practice Address - Phone:412-687-3842
Practice Address - Fax:412-687-8212
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002497103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA29756Medicare UPIN