Provider Demographics
NPI:1699310797
Name:DUGAN-REILLY, KRISTIN LEIGH
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:DUGAN-REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1923
Mailing Address - Country:US
Mailing Address - Phone:516-242-5591
Mailing Address - Fax:
Practice Address - Street 1:100 HORSEBLOCK RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4385
Practice Address - Country:US
Practice Address - Phone:631-737-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070162-021041C0700X
NY0701621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical