Provider Demographics
NPI:1306184395
Name:DR. DAWN REILLY, L.L.C.
Entity Type:Organization
Organization Name:DR. DAWN REILLY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-993-3838
Mailing Address - Street 1:817 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3309
Mailing Address - Country:US
Mailing Address - Phone:954-993-3838
Mailing Address - Fax:954-343-1147
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:SUITE 121
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3309
Practice Address - Country:US
Practice Address - Phone:954-993-3838
Practice Address - Fax:954-343-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty