Provider Demographics
NPI:1346401585
Name:DE PEYER-REILLY, JANINE CAROL (LCSW)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:CAROL
Last Name:DE PEYER-REILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:CAROL
Other - Last Name:DE PEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1327 LEXINGTON AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1109
Mailing Address - Country:US
Mailing Address - Phone:212-369-6551
Mailing Address - Fax:
Practice Address - Street 1:1327 LEXINGTON AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1109
Practice Address - Country:US
Practice Address - Phone:212-369-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYR041440-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical