Healthcare Provider Details

I. General information

NPI: 1427068733
Provider Name (Legal Business Name): JAMES PETER REILLY LCMHC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEDGEHILL RD
BENNINGTON VT
05201-2273
US

IV. Provider business mailing address

100 LEDGEHILL RD
BENNINGTON VT
05201-2273
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-5491
  • Fax: 802-442-3363
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number000202
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0680000302
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000202
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0680000302
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000202
License Number StateVT
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000302
License Number StateVT
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000202
License Number StateVT
# 8
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number068-0000302
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: