Provider Demographics
NPI:1912564824
Name:REILLY, LIAM (PHD)
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:
Last Name:REILLY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 W 90TH ST
Mailing Address - Street 2:APT 7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1555
Mailing Address - Country:US
Mailing Address - Phone:510-387-6267
Mailing Address - Fax:
Practice Address - Street 1:515 MADISON AVE
Practice Address - Street 2:FL 21
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5433
Practice Address - Country:US
Practice Address - Phone:718-519-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical