Provider Demographics
NPI:1811331333
Name:REILLY, KATHLEEN M (LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:REILLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WOOD AVE SOUTH
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830
Mailing Address - Country:US
Mailing Address - Phone:732-536-0076
Mailing Address - Fax:732-972-8846
Practice Address - Street 1:33 WOOD AVE S
Practice Address - Street 2:SUITE 400
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2735
Practice Address - Country:US
Practice Address - Phone:732-536-0076
Practice Address - Fax:732-972-8846
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00468300101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor