Provider Demographics
NPI:1285818716
Name:CASE, REILLY SEAN
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:SEAN
Last Name:CASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1532
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0532
Mailing Address - Country:US
Mailing Address - Phone:949-602-0029
Mailing Address - Fax:714-964-6919
Practice Address - Street 1:19582 BEACH BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:949-602-0029
Practice Address - Fax:714-964-6919
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CALCS197411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical