Provider Demographics
NPI:1114356813
Name:RADELL-REILLY, JOSEPH ANTHONY-PORTO (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY-PORTO
Last Name:RADELL-REILLY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:3017 ELSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2312
Mailing Address - Country:US
Mailing Address - Phone:734-846-2848
Mailing Address - Fax:
Practice Address - Street 1:15700 W 10 MILE RD STE 106
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2100
Practice Address - Country:US
Practice Address - Phone:989-225-4111
Practice Address - Fax:248-575-4555
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010961691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical