Provider Demographics
NPI:1467522318
Name:REILLY, KATHLEEN JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JEAN
Last Name:REILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9547
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37940-0547
Mailing Address - Country:US
Mailing Address - Phone:865-688-1220
Mailing Address - Fax:865-577-0688
Practice Address - Street 1:5112 SCHUBERT RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-3832
Practice Address - Country:US
Practice Address - Phone:865-688-1220
Practice Address - Fax:865-577-0688
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0003891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical