Provider Demographics
NPI:1689884322
Name:REILLY, JOHN F (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:F
Last Name:REILLY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SPAULDING RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1022
Mailing Address - Country:US
Mailing Address - Phone:978-250-8092
Mailing Address - Fax:
Practice Address - Street 1:16 SPAULDING RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1022
Practice Address - Country:US
Practice Address - Phone:978-250-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1072961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAREIPO5852OtherBLUE CROSS BLUE SHIELD OF