Provider Demographics
NPI:1972704419
Name:REESE, ABBY RUSSIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:RUSSIN
Last Name:REESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:RUSSIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1516 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4225
Mailing Address - Country:US
Mailing Address - Phone:570-287-5200
Mailing Address - Fax:570-609-1551
Practice Address - Street 1:1516 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4225
Practice Address - Country:US
Practice Address - Phone:570-287-5200
Practice Address - Fax:570-609-1551
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017157103TC0700X
PAPS016373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical