Provider Demographics
NPI:1003939588
Name:REILLY, WINIFRED MULLINACK (MA, MFT)
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:MULLINACK
Last Name:REILLY
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 MILVIA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1935
Mailing Address - Country:US
Mailing Address - Phone:510-528-0802
Mailing Address - Fax:
Practice Address - Street 1:1314 MILVIA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1935
Practice Address - Country:US
Practice Address - Phone:510-528-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT19106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist