Provider Demographics
NPI:1366002982
Name:REILLY, BRIGID A
Entity Type:Individual
Prefix:
First Name:BRIGID
Middle Name:A
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 1:25 BIRCH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3585
Mailing Address - Country:US
Mailing Address - Phone:774-804-3376
Mailing Address - Fax:508-634-4345
Practice Address - Street 1:25 BIRCH ST STE 250
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3585
Practice Address - Country:US
Practice Address - Phone:774-804-3376
Practice Address - Fax:508-634-4345
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health