MEDICARE: MS. KATHLEEN M REILLY LPC

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	101Y00000X	Counselor	37PC00468300	NJ

General Provider Information

NPI Number	:	1811331333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN M REILLY LPC

Provider Business Mailing Address
First Line	:	33 WOOD AVE SOUTH
Second Line	:	SUITE 400
City	:	ISELIN
State	:	NJ
Zip	:	08830
Country	:	US
Telephone Number	:	732-536-0076
Fax Number	:	732-972-8846

Provider Business Practice Location Address
First Line	:	33 WOOD AVE S
Second Line	:	SUITE 400
City	:	ISELIN
State	:	NJ
Zip	:	08830-2735
Country	:	US
Telephone Number	:	732-536-0076
Fax Number	:	732-972-8846

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

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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