Provider Demographics
NPI:1093183816
Name:REILLY, BRIDGET (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 WAYNE ST APT 412C
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6306
Mailing Address - Country:US
Mailing Address - Phone:732-492-5833
Mailing Address - Fax:
Practice Address - Street 1:187 WAYNE ST APT 412C
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-6306
Practice Address - Country:US
Practice Address - Phone:732-492-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC0319-6051041C0700X
NY088354-11041C0700X
NJ44SC058508001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical