Provider Demographics
NPI:1386868206
Name:REILLEY, ROSIE DELGADILLO (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ROSIE
Middle Name:DELGADILLO
Last Name:REILLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 WALNUT CREEK COURT
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8159
Mailing Address - Country:US
Mailing Address - Phone:208-466-5847
Mailing Address - Fax:
Practice Address - Street 1:16 12TH AVE SOUTH
Practice Address - Street 2:STE 103
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:208-461-3720
Practice Address - Fax:208-461-1787
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-2621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0000155999OtherBLUE CROSS