Provider Demographics
NPI:1598815722
Name:DERANEY REILLY, SANDRA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:DERANEY REILLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:M
Other - Last Name:DERANEY-REILLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:222 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2812
Mailing Address - Country:US
Mailing Address - Phone:970-498-0560
Mailing Address - Fax:970-224-2126
Practice Address - Street 1:222 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2812
Practice Address - Country:US
Practice Address - Phone:970-498-0560
Practice Address - Fax:970-224-2126
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist