Provider Demographics
NPI:1376861005
Name:REILLY, MICHAEL (BS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:REILLY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MAIN ST STE 560
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1817
Mailing Address - Country:US
Mailing Address - Phone:508-890-6519
Mailing Address - Fax:508-363-0562
Practice Address - Street 1:484 MAIN ST STE 560
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1817
Practice Address - Country:US
Practice Address - Phone:508-890-6519
Practice Address - Fax:508-363-0562
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor