Provider Demographics
NPI:1083467971
Name:BARTH, REILLY (LLMSW)
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:
Last Name:BARTH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 S CUMMINGS ST
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9457
Mailing Address - Country:US
Mailing Address - Phone:702-592-2078
Mailing Address - Fax:
Practice Address - Street 1:25600 WOODWARD AVE STE 215
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0945
Practice Address - Country:US
Practice Address - Phone:248-399-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23221130823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker