Provider Demographics
NPI:1750788980
Name:REILLY, MICHAEL FALCON (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FALCON
Last Name:REILLY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:KORNYLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:932 WARD AVE STE 490
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2193
Mailing Address - Country:US
Mailing Address - Phone:804-647-2632
Mailing Address - Fax:
Practice Address - Street 1:932 WARD AVE STE 490
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2193
Practice Address - Country:US
Practice Address - Phone:804-647-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
HIPSY-1658103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health