MEDICARE: THOMAS REILLY LADC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	000951	CT
2	101YM0800X	Mental Health Counselor	002448	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326316886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS REILLY LADC, LPC

Provider Business Mailing Address
First Line	:	30 HAZEL TER STE 11
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2240
Country	:	US
Telephone Number	:	203-819-7650
Fax Number	:	203-298-9487

Provider Business Practice Location Address
First Line	:	30 HAZEL TERRACE
Second Line	:	SUITE 11
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2209
Country	:	US
Telephone Number	:	203-819-7650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	12/10/2025

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