Provider Demographics
NPI:1447319280
Name:REILLY, DAWN M (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:REILLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3309
Mailing Address - Country:US
Mailing Address - Phone:954-993-3838
Mailing Address - Fax:954-343-1147
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:SUITE 121
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3309
Practice Address - Country:US
Practice Address - Phone:954-993-3838
Practice Address - Fax:954-343-1147
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical