Healthcare Provider Details

I. General information

NPI: 1821849720
Provider Name (Legal Business Name): STEVEN LILLY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 N CALAIS RD
EAST CALAIS VT
05650-8063
US

IV. Provider business mailing address

480 CLIF REYNOLDS RD
JEFFERSONVILLE VT
05464-9474
US

V. Phone/Fax

Practice location:
  • Phone: 845-392-5510
  • Fax:
Mailing address:
  • Phone: 845-392-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0134320
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: