Healthcare Provider Details

I. General information

NPI: 1770573818
Provider Name (Legal Business Name): MELISSA ELIZABETH DERBY REILLY PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 E PERKIOMEN AVENUE
BIRDSBORO PA
19508-9178
US

IV. Provider business mailing address

6720 PERKIOMEN AVE
BIRDSBORO PA
19508-9178
US

V. Phone/Fax

Practice location:
  • Phone: 610-404-1726
  • Fax:
Mailing address:
  • Phone: 610-404-1726
  • Fax: 610-404-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS009241L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: