Basic Information
| Provider Information | |||||||||
| NPI: | 1851890297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REISINGER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 KOLBE RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440531652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409603954 | ||||||||
| FaxNumber: | 4409603956 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 KOLBE RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440531652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409603954 | ||||||||
| FaxNumber: | 4409603956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2018 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | P.07692 | OH | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0381878 | 05 | OH | MEDICAID |