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General NPI Number Information
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NPI Number | 1134557689
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Entity Type | Organization
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Legal Business Name | CAROL REILLY LCC
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Dates
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Enumeration Date | 10/19/2013
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Last Update Date | 10/19/2013
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Provider Practice Location Address
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Address Line | 101 CHESTNUT ST APT H
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City | BETHEL
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State | CT
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Zip | 06801-2660
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Country | US
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Telephone | 203-743-6117
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CHESTNUT ST APT H
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City | BETHEL
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State | CT
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Zip | 06801-2660
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Country | US
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Telephone | 203-743-6117
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | CAROL REILLY
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Credential | LPC
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Telephone | 203-743-6117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001659
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License Number State | CT
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