MEDICARE: DEBORAH MARIE REILLY

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
1	1041C0700X	Clinical Social Worker	SW19885	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144566373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH MARIE REILLY

Provider Business Mailing Address
First Line	:	41 LAKE FOREST PL
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8044
Country	:	US
Telephone Number	:	386-503-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1176 PELICAN BAY DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1381
Country	:	US
Telephone Number	:	386-503-0522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2012
Last Update Date	:	06/27/2022

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Directions to “ DEBORAH MARIE REILLY ” Practice Location

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