Provider Demographics
NPI:1174091581
Name:SANDRA MARIE DERANEY-REILLY
Entity type:Organization
Organization Name:SANDRA MARIE DERANEY-REILLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERANEY-REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-419-0999
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:970-282-8699
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:970-282-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty