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NPI Code Detail

MEDICARE: SANDRA MARIE DERANEY-REILLY

MEDICARE: SANDRA MARIE DERANEY-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
1103T00000XPsychologist

General Provider Information

NPI Number : 1174091581
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANDRA MARIE DERANEY-REILLY
Provider Business Mailing Address
First Line : 222 W MAGNOLIA ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80521-2812
Country : US
Telephone Number : 970-498-0560
Fax Number : 970-282-8699
Provider Business Practice Location Address
First Line : 222 W MAGNOLIA ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80521-2812
Country : US
Telephone Number : 970-498-0560
Fax Number : 970-282-8699
Authorized Official
Title or Position : LICENSED PSYCHOLOGIST
Name : SANDRA DERANEY-REILLY
Credential : PHD
Telephone Number : 970-419-0999
Provider Enumeration Date : 11/05/2018
Last Update Date : 04/22/2019

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Directions to “SANDRA MARIE DERANEY-REILLY ” Practice Location

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