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NPI Code Detail

MEDICARE: MRS. LISA JILL REILLY LCSW

MEDICARE: MRS. LISA JILL REILLY LCSW
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
11041C0700XClinical Social Worker072021NY

General Provider Information

NPI Number : 1922315878
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA JILL REILLY LCSW
Provider Business Mailing Address
First Line : 7 RIUNITE RD
Second Line :
City : EAST SETAUKET
State : NY
Zip : 11733-2663
Country : US
Telephone Number : 631-246-5020
Fax Number : 631-476-9322
Provider Business Practice Location Address
First Line : 118 SPRING ST
Second Line :
City : PORT JEFFERSON
State : NY
Zip : 11777-1817
Country : US
Telephone Number : 631-476-0564
Fax Number : 631-476-9322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2010
Last Update Date : 09/13/2010

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