Provider Demographics
NPI:1932541117
Name:REILLY, JUSTINA ANNE (LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:ANNE
Last Name:REILLY
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:JUSTINA
Other - Middle Name:ANNE
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3031
Mailing Address - Country:US
Mailing Address - Phone:347-609-5875
Mailing Address - Fax:
Practice Address - Street 1:54 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3031
Practice Address - Country:US
Practice Address - Phone:347-609-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health