Provider Demographics
NPI:1790800514
Name:REYERING, SALLY ANN (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:REYERING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CANAL ST
Mailing Address - Street 2:BAY COVE HUMAN SERVICES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-788-1743
Mailing Address - Fax:617-371-3046
Practice Address - Street 1:170 MORTON ST
Practice Address - Street 2:MICHAEL J. GILL MENTAL HEALTH AND WELLNESS CLINIC
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-619-5908
Practice Address - Fax:617-971-3853
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA605612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84797Medicare UPIN