Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35SI00385000 | NJ |
Y | 103T00000X | Psychologist | 35SI00385000 | NJ |
NPI | 1003938812 |
---|---|
Provider Name | Dr. Dolores Ann Reilly |
First Address | Manasquan, NJ 08736-1352 |
Second Address | Manasquan, NJ 08736-1352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P2559636 | OXFORD (01) | NJ |