Doctor Name: | MS. STACY MARIE REILLY |
NPI Number: | 1245270800 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 072880-1 |
Business Practice Address: | 138 North Court St. Veterans Memorial Bldg Wampsville, NY - 131630608 |
Business Phone Number: | 3153662327 |
Business Fax Number: | |
Mailing Address: | 104 Kenny St, FAYETTEVILLE |
State: | NY |
Postal Code: | 130661231 |
Phone Number: | 3153662327 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2006 |
NPI Last Update Date: | 09/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 072880-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |