Healthcare Provider Details

I. General information

NPI: 1972134351
Provider Name (Legal Business Name): HILARY REILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GREEN ST
ITHACA NY
14850-5635
US

IV. Provider business mailing address

1308 BABCOCK HOLLOW RD
MARATHON NY
13803-1005
US

V. Phone/Fax

Practice location:
  • Phone: 607-744-7752
  • Fax:
Mailing address:
  • Phone: 607-744-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088100-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: