Provider Demographics
NPI:1336385632
Name:REILLY, MEREDITH ANNE (M ED, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:ANNE
Last Name:REILLY
Suffix:
Gender:F
Credentials:M ED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-1557
Mailing Address - Country:US
Mailing Address - Phone:774-722-9372
Mailing Address - Fax:
Practice Address - Street 1:411 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1843
Practice Address - Country:US
Practice Address - Phone:774-722-9372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health