Healthcare Provider Details

I. General information

NPI: 1619046356
Provider Name (Legal Business Name): BERNARD C O'REILLY LSW, CCDC III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 COLUMBUS PIKE STE A
LEWIS CENTER OH
43035-8495
US

IV. Provider business mailing address

6011 COLUMBUS PIKE STE A
LEWIS CENTER OH
43035-8495
US

V. Phone/Fax

Practice location:
  • Phone: 614-635-9011
  • Fax: 614-635-9014
Mailing address:
  • Phone: 614-635-9011
  • Fax: 614-635-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS 0024346
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number954344
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: