Provider Demographics
NPI:1699084137
Name:REIS, DIANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:REIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E STREET, SE, #300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2620
Mailing Address - Country:US
Mailing Address - Phone:202-577-8183
Mailing Address - Fax:301-320-7945
Practice Address - Street 1:50 E ST SE STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2620
Practice Address - Country:US
Practice Address - Phone:202-577-8183
Practice Address - Fax:301-320-7945
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY 1000628103TC0700X
VA0810004248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical