Basic Information
| Provider Information | |||||||||
| NPI: | 1417044769 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REILLY | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1207 NARRUMSON RD | ||||||||
| Address2: | |||||||||
| City: | MANASQUAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087362026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322235530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1945 STATE ROUTE 33 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327762325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 44SL05224100 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.