Provider Demographics
NPI:1346603446
Name:REILLY, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:REILLY
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 1:376 LAFAYETTE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3560
Mailing Address - Country:US
Mailing Address - Phone:973-940-0105
Mailing Address - Fax:
Practice Address - Street 1:376 LAFAYETTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3560
Practice Address - Country:US
Practice Address - Phone:973-940-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor