Healthcare Provider Details

I. General information

NPI: 1841381142
Provider Name (Legal Business Name): SHOUDT & REILLY PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 PERKIOMEN AVE # A
READING PA
19606-9521
US

IV. Provider business mailing address

4730 PERKIOMEN AVE # A
READING PA
19606-9521
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-1370
  • Fax: 610-898-1259
Mailing address:
  • Phone: 610-898-1370
  • Fax: 610-898-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1677265
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 2
Identifier50005217
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS

VIII. Authorized Official

Name: DR. MELISSA E. D. REILLY
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 610-898-1370