Provider Demographics
NPI:1033269550
Name:REILLY, ERNEST WILLIAM (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:WILLIAM
Last Name:REILLY
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536040
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32853-6040
Mailing Address - Country:US
Mailing Address - Phone:407-843-4968
Mailing Address - Fax:407-447-4543
Practice Address - Street 1:1630 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4810
Practice Address - Country:US
Practice Address - Phone:407-843-4968
Practice Address - Fax:407-447-4543
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW50411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical