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NPI Code Detail

MEDICARE: MRS. KELLEY FORBES REILLY MSW, LICSW

MEDICARE: MRS. KELLEY FORBES REILLY MSW, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLW00008843WA
21041C0700XClinical Social WorkerISW02557RI

General Provider Information

NPI Number : 1033163498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLEY FORBES REILLY MSW, LICSW
Provider Business Mailing Address
First Line : 6 JOHN H CHAFEE BLVD
Second Line :
City : NEWPORT
State : RI
Zip : 02840-1034
Country : US
Telephone Number : 401-848-2160
Fax Number :
Provider Business Practice Location Address
First Line : 6 JOHN H CHAFEE BLVD
Second Line :
City : NEWPORT
State : RI
Zip : 02840-1034
Country : US
Telephone Number : 401-848-2160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 01/05/2018

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