Provider Demographics
NPI:1598656779
Name:REILLY, KATHERINE BETH
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:BETH
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 1:8822 SHADY PINES DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-6771
Mailing Address - Country:US
Mailing Address - Phone:301-514-1401
Mailing Address - Fax:
Practice Address - Street 1:9093 RIDGEFIELD DR STE 207
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6712
Practice Address - Country:US
Practice Address - Phone:240-457-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health