Healthcare Provider Details

I. General information

NPI: 1225960297
Provider Name (Legal Business Name): REILLEY BALDWIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-57 HARRISON ST
JOHNSON CITY NY
13790-2107
US

IV. Provider business mailing address

33 LEWIS RD
BINGHAMTON NY
13905-1048
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-6622
  • Fax:
Mailing address:
  • Phone: 607-770-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128080
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: