Provider Demographics
NPI:1003910662
Name:REILLY, JOSEPH F (MA, MT-BC, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:F
Last Name:REILLY
Suffix:
Gender:M
Credentials:MA, MT-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TREE TOPS RD
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-1028
Mailing Address - Country:US
Mailing Address - Phone:610-255-1350
Mailing Address - Fax:610-255-5750
Practice Address - Street 1:1 TREE TOPS RD
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-1028
Practice Address - Country:US
Practice Address - Phone:610-255-1350
Practice Address - Fax:610-255-5750
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018634570003Medicaid