Provider Demographics
NPI:1770573818
Name:REILLY, MELISSA ELIZABETH DERBY (PSY D)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ELIZABETH DERBY
Last Name:REILLY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 PERKIOMEN AVE
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-9178
Mailing Address - Country:US
Mailing Address - Phone:610-404-1726
Mailing Address - Fax:610-404-1734
Practice Address - Street 1:6720 E PERKIOMEN AVENUE
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-9178
Practice Address - Country:US
Practice Address - Phone:610-404-1726
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009241L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA271459000OtherMAGELLAN BEHAVIORAL HLTH
PA50045517OtherCAPITAL BLUE CROSS
PA7068219OtherAETNA
PA1331839OtherHIGHMARK BLUE SHIELD
PA7068219OtherAETNA