Provider Demographics
NPI:1336355981
Name:O'REILLY, KERRY ELIZABETH (PSYD, LMFT)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:ELIZABETH
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 TELEGRAPH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3250
Mailing Address - Country:US
Mailing Address - Phone:805-642-4611
Mailing Address - Fax:805-585-3241
Practice Address - Street 1:3160 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3250
Practice Address - Country:US
Practice Address - Phone:805-642-4611
Practice Address - Fax:805-585-3241
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT42870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800687250Medicaid