MEDICARE: MARY REILLY MA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1558513705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY REILLY MA

Provider Business Mailing Address
First Line	:	333 E CENTER ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-4142
Country	:	US
Telephone Number	:	614-445-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 E CENTER ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-4142
Country	:	US
Telephone Number	:	614-445-8131
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	01/18/2022

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Directions to “ MARY REILLY MA” Practice Location

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