| Doctor Name: | DR. CHARLES J REILLY |
| NPI Number: | 1356301295 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.D. |
| License Number: | |
| Business Practice Address: | 158 Upland Rd Waban, MA - 024682005 |
| Business Phone Number: | 6175275561 |
| Business Fax Number: | |
| Mailing Address: | 158 Upland Rd, WABAN |
| State: | MA |
| Postal Code: | 024682005 |
| Phone Number: | 6175275561 |
| Fax Number: | |
| NPI Enumeration Date: | 03/24/2006 |
| NPI Last Update Date: | 05/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TF0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Forensic |
| Taxonomy Definition: | |