Provider Demographics
NPI:1710030622
Name:REILLY, DIANA KEIR (MS)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:KEIR
Last Name:REILLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SUMMIT CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6753
Mailing Address - Country:US
Mailing Address - Phone:802-238-1595
Mailing Address - Fax:
Practice Address - Street 1:3 MAIN ST
Practice Address - Street 2:CORNERSTONE PSYCHOTHERAPY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5216
Practice Address - Country:US
Practice Address - Phone:802-651-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000201101YA0400X
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT783679OtherMVP PROVIDER NUMBER
VT1010816Medicaid