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NPI Code Detail

MEDICARE: KAITLYN LIANE REILLY

MEDICARE: KAITLYN LIANE REILLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2104100000XSocial WorkerASW83651CA
3390200000XStudent in an Organized Health Care Education/Training ProgramCA
41041C0700XClinical Social WorkerLCSW107788CA

General Provider Information

NPI Number : 1205381613
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN LIANE REILLY
Provider Business Mailing Address
First Line : 1141 LEVER BLVD
Second Line :
City : STOCKTON
State : CA
Zip : 95206-2855
Country : US
Telephone Number : 209-681-6421
Fax Number :
Provider Business Practice Location Address
First Line : 1141 LEVER BLVD
Second Line :
City : STOCKTON
State : CA
Zip : 95206-2855
Country : US
Telephone Number : 209-681-6421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2016
Last Update Date : 04/29/2024

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Directions to “ KAITLYN LIANE REILLY ” Practice Location

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