Provider Demographics
NPI:1902163439
Name:REILLY, KRISTEL LYNN
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:LYNN
Last Name:REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 VOLPE DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-5537
Mailing Address - Country:US
Mailing Address - Phone:225-571-5996
Mailing Address - Fax:
Practice Address - Street 1:3909 BIENVILLE ST STE 102
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5151
Practice Address - Country:US
Practice Address - Phone:225-571-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2012-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical