Provider Demographics
NPI:1164014643
Name:REILLY, MARY ELIZA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZA
Last Name:REILLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 TILDEN ST NW APT 504
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3081
Mailing Address - Country:US
Mailing Address - Phone:202-255-5064
Mailing Address - Fax:
Practice Address - Street 1:3020 TILDEN ST NW APT 504
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3081
Practice Address - Country:US
Practice Address - Phone:202-255-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500827971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical