Provider Demographics
NPI:1083013031
Name:REILLY, KELLY (MSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 NEWELL ST
Mailing Address - Street 2:4R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4288
Mailing Address - Country:US
Mailing Address - Phone:917-474-9872
Mailing Address - Fax:
Practice Address - Street 1:109 NEWELL ST
Practice Address - Street 2:4R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4288
Practice Address - Country:US
Practice Address - Phone:917-474-9872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health