Provider Demographics
NPI:1841381142
Name:SHOUDT & REILLY PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:SHOUDT & REILLY PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:E D
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-898-1370
Mailing Address - Street 1:4730 PERKIOMEN AVE # A
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9521
Mailing Address - Country:US
Mailing Address - Phone:610-898-1370
Mailing Address - Fax:610-898-1259
Practice Address - Street 1:4730 PERKIOMEN AVE # A
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9521
Practice Address - Country:US
Practice Address - Phone:610-898-1370
Practice Address - Fax:610-898-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1677265OtherHIGHMARK BLUE SHIELD
PA50005217OtherCAPITAL BLUE CROSS
PA50005217OtherCAPITAL BLUE CROSS