Provider Demographics
NPI:1174306260
Name:REIS, NANCY KAREN (LADC-I, MATC, FAC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KAREN
Last Name:REIS
Suffix:
Gender:F
Credentials:LADC-I, MATC, FAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NORTH ST STE 26A
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5102
Mailing Address - Country:US
Mailing Address - Phone:413-212-0846
Mailing Address - Fax:
Practice Address - Street 1:150 NORTH ST STE 26A
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5102
Practice Address - Country:US
Practice Address - Phone:413-212-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20460101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)