Individual provider Active NPI

Rebecca Reilly, LCSW

  • Clinical Social Worker
  • Branford, CT
National Provider Identifier
1831438068
Registry record updated Feb 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
007609 Issued in CT
Practice address
342 Harbor St
Branford, CT 06405-4540
Phone
(203) 481-4248
Fax
(203) 483-7727
NPI assigned
Feb 7, 2013
Last updated
Feb 7, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 007609 CT Primary

Addresses

Primary practice location

342 Harbor St
Branford, CT 06405-4540

Mailing address

211 East Main Street
37D
Branford, CT 06405
Phone (203) 454-0414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150522000698 CT Practitioner - Clinical Social Worker 1759601388 Practice locations: Branford, CT

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007609CTMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360195200000",
    "number": "1831438068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 EAST MAIN STREET",
            "address_2": "37D",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "06405",
            "telephone_number": "203-454-0414",
            "fax_number": "203-483-7727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 HARBOR ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064054540",
            "telephone_number": "203-481-4248",
            "fax_number": "203-483-7727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REILLY",
        "first_name": "REBECCA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-07",
        "last_updated": "2013-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "007609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Branford, CT

Sources for this page

Verify at the official NPI Registry.