Provider Demographics
NPI:1114793692
Name:REILLY, ALLISON LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LOUISE
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 1:10099 WINDWARD PASS
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8991
Mailing Address - Country:US
Mailing Address - Phone:931-217-6372
Mailing Address - Fax:
Practice Address - Street 1:557 PIT RD
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7831
Practice Address - Country:US
Practice Address - Phone:317-793-8931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010792A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical