MEDICARE: EDWARD J O'REILLY LICDC-CS

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.933651	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	933651	OTHER	OH	OHIO CHEMICAL DEPENDENCY PROFESSIONALS BOARD

General Provider Information

NPI Number	:	1578012373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD J O'REILLY LICDC-CS

Provider Business Mailing Address
First Line	:	899 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1156
Country	:	US
Telephone Number	:	614-220-8655
Fax Number	:	614-220-8658

Provider Business Practice Location Address
First Line	:	1115 S HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1311
Country	:	US
Telephone Number	:	380-201-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	03/17/2024

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