Provider Demographics
NPI:1982112827
Name:REILLY, TERENCE JOSEPH
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:JOSEPH
Last Name:REILLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MONTAUK HIGHWAY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719-9715
Practice Address - Country:US
Practice Address - Phone:631-647-9011
Practice Address - Fax:631-647-9012
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical