Provider Demographics
NPI:1396121018
Name:O'REILLY, MARY KATHERINE (MSED)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HMS STAYNER DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1664
Mailing Address - Country:US
Mailing Address - Phone:179-576-4516
Mailing Address - Fax:781-385-7324
Practice Address - Street 1:105 HMS STAYNER DR
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1664
Practice Address - Country:US
Practice Address - Phone:179-576-4516
Practice Address - Fax:781-385-7324
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2997103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst