Kevin T Reilly, M.A., L.L.P.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006428 Issued in MI

Practice address

23400 Michigan Ave
Suite 702
Dearborn, MI 48124-1924

Phone

(313) 274-1656

Fax

(313) 274-3010

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891705141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44242 ARLINGTON RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872144",
            "telephone_number": "313-274-1656",
            "fax_number": "313-274-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23400 MICHIGAN AVE",
            "address_2": "SUITE 702",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241924",
            "telephone_number": "313-274-1656",
            "fax_number": "313-274-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REILLY",
        "first_name": "KEVIN",
        "middle_name": "T",
        "credential": "M.A., L.L.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Audrey Marguerite Renaud

• Clinical Psychologist in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.