MEDICARE: MS. SUZANNE MARIE REILLY MS

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1407125842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE MARIE REILLY MS

Provider Business Mailing Address
First Line	:	2727 CROMPOND ROAD
Second Line	:	YORKTOWN HIGH SCHOOL
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598
Country	:	US
Telephone Number	:	914-243-8050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 CROMPOND RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3129
Country	:	US
Telephone Number	:	914-243-8050
Fax Number	:

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

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	12/14/2011

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