Provider Demographics
NPI:1407125842
Name:REILLY, SUZANNE MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:REILLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 CROMPOND ROAD
Mailing Address - Street 2:YORKTOWN HIGH SCHOOL
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598
Mailing Address - Country:US
Mailing Address - Phone:914-243-8050
Mailing Address - Fax:
Practice Address - Street 1:2727 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-3129
Practice Address - Country:US
Practice Address - Phone:914-243-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool