Provider Demographics
NPI:1598179723
Name:O'REILLY, DEIRDRE M (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:M
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 GRAND AVE
Mailing Address - Street 2:APT 4G
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3533
Mailing Address - Country:US
Mailing Address - Phone:201-674-7510
Mailing Address - Fax:
Practice Address - Street 1:109 GRAND AVE
Practice Address - Street 2:APT 4G
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3533
Practice Address - Country:US
Practice Address - Phone:201-674-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05846700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker