Active NPI
Charles J Reilly, ED.D.
- Clinical Psychologist
- Waban, MA
National Provider Identifier
1356301295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3037
- Practice address
- 158 Upland Rd
Waban, MA 02468-2005 - Phone
- (617) 527-5561
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3037 | MA | Primary |
| Forensic Psychologist | 103TF0200X | |||
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X |
Addresses
Primary practice location
158 Upland Rd
Waban, MA 02468-2005
Mailing address
158 Upland Rd
Waban, MA 02468-2005
Phone (617) 527-5561
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400716800000",
"number": "1356301295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "158 UPLAND RD",
"city": "WABAN",
"state": "MA",
"postal_code": "024682005",
"telephone_number": "617-527-5561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "158 UPLAND RD",
"city": "WABAN",
"state": "MA",
"postal_code": "024682005",
"telephone_number": "617-527-5561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILLY",
"first_name": "CHARLES",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2014-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "3037",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waban, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.