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General NPI Number Information
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NPI Number | 1699310797
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Entity Type | Individual
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Provider Name | KRISTIN LEIGH DUGAN-REILLY
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Gender | Female
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 100 HORSEBLOCK RD
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City | CENTEREACH
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State | NY
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Zip | 11720-4385
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Country | US
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Telephone | 631-737-8192
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Fax |
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Provider Business Mailing Address
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Address Line | 488 DEER PARK AVE
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City | BABYLON
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State | NY
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Zip | 11702-1923
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Country | US
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Telephone | 516-242-5591
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 070162-02
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 070162
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License Number State | NY
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