Provider Demographics
NPI:1790196095
Name:REILLY, LYNN (MS)
Entity Type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:
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 1:161 N FARMS RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1271
Mailing Address - Country:US
Mailing Address - Phone:860-888-3289
Mailing Address - Fax:
Practice Address - Street 1:161 N FARMS RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1271
Practice Address - Country:US
Practice Address - Phone:860-888-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional