Provider Demographics
NPI:1275397366
Name:MCGLONE, REILLY CAITLIN
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:CAITLIN
Last Name:MCGLONE
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 1:2308 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1624
Mailing Address - Country:US
Mailing Address - Phone:508-280-0880
Mailing Address - Fax:
Practice Address - Street 1:505 WINDY KNOLL DRIVE,
Practice Address - Street 2:#323 MOUNT AIRY, MD 21771
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21771-9998
Practice Address - Country:US
Practice Address - Phone:240-668-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician