Active NPI
Edwin H. Reisfeld, PHD
- Clinical Psychologist
- Charlotte, NC
National Provider Identifier
1457340952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3748
- Practice address
- 15720 John J Delaney Dr
Suite 300
Charlotte, NC 28277-3430 - Phone
- (704) 927-5881
- Fax
- (704) 944-3201
- NPI assigned
- Oct 18, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3748 | NC | Primary |
Addresses
Primary practice location
15720 John J Delaney Dr
Suite 300
Charlotte, NC 28277-3430
Mailing address
52511 Winchester Street
Fort Mill, SC 29707
Phone (704) 927-5881
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2826004A | Other | NC | MEDICARE INDIVIDUAL PTAN |
| 2826004 | Other | NC | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3748 | NC | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313971200000",
"number": "1457340952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52511 WINCHESTER STREET",
"city": "FORT MILL",
"state": "SC",
"postal_code": "29707",
"telephone_number": "704-927-5881",
"fax_number": "704-944-3201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15720 JOHN J DELANEY DR",
"address_2": "SUITE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282773430",
"telephone_number": "704-927-5881",
"fax_number": "704-944-3201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REISFELD",
"first_name": "EDWIN",
"middle_name": "H.",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-18",
"last_updated": "2011-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "3748",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE INDIVIDUAL PTAN",
"identifier": "2826004A",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "2826004",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.