Provider Demographics
NPI:1144566373
Name:REILLY, DEBORAH MARIE
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIE
Last Name:REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LAKE FOREST PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8044
Mailing Address - Country:US
Mailing Address - Phone:386-503-0522
Mailing Address - Fax:
Practice Address - Street 1:1176 PELICAN BAY DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1381
Practice Address - Country:US
Practice Address - Phone:386-503-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-16
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW198851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical