Provider Demographics
NPI:1134557689
Name:CAROL REILLY LCC
Entity type:Organization
Organization Name:CAROL REILLY LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-743-6117
Mailing Address - Street 1:101 CHESTNUT ST APT H
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2660
Mailing Address - Country:US
Mailing Address - Phone:203-743-6117
Mailing Address - Fax:
Practice Address - Street 1:101 CHESTNUT ST APT H
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2660
Practice Address - Country:US
Practice Address - Phone:203-743-6117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-19
Last Update Date:2013-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty