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General NPI Number Information
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NPI Number | 1184171324
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Entity Type | Individual
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Provider Name | SHANNON MARIE REILLEY LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 604 SOLAREX CT UNIT 201
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City | FREDERICK
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State | MD
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Zip | 21703-8655
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Country | US
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Telephone | 301-663-8263
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Fax |
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Provider Business Mailing Address
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Address Line | 35 E CHURCH ST UNIT A
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City | MOUNT AIRY
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State | MD
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Zip | 21771-5463
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Country | US
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Telephone | 240-527-9395
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Fax | 410-334-6362
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22951
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License Number State | MD
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