Provider Demographics
NPI:1376435230
Name:REISS, PATRICK ELLIOT (NCC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ELLIOT
Last Name:REISS
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-6208
Mailing Address - Country:US
Mailing Address - Phone:908-421-0842
Mailing Address - Fax:
Practice Address - Street 1:53 CANTERBURY CT
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-6208
Practice Address - Country:US
Practice Address - Phone:908-421-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1738206101Y00000X
NJ37AC00891100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor