Provider Demographics
NPI:1467002659
Name:LILLEY, MEGAN K
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:LILLEY
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 1:10912 MARRIOTTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1112
Mailing Address - Country:US
Mailing Address - Phone:443-934-3547
Mailing Address - Fax:
Practice Address - Street 1:10912 MARRIOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-1112
Practice Address - Country:US
Practice Address - Phone:443-934-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician