Basic Information
| Provider Information | |||||||||
| NPI: | 1700959665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REILLY | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 MERRIAM ST | ||||||||
| Address2: | |||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010282317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135256547 | ||||||||
| FaxNumber: | 4135256547 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011051864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137327419 | ||||||||
| FaxNumber: | 4137373000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| 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 | 101YM0800X | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.