Provider Demographics
NPI:1427068733
Name:REILLY, JAMES PETER (LCMHC, LADC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PETER
Last Name:REILLY
Suffix:
Gender:M
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LEDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 LEDGEHILL RD
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2273
Practice Address - Country:US
Practice Address - Phone:802-442-5491
Practice Address - Fax:802-442-3363
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000202101Y00000X, 101YA0400X, 101YM0800X, 103T00000X
VT0680000302101Y00000X, 101YA0400X
VT068-0000302101YM0800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
29290OtherBLUE CROSS
2032395OtherCIGNA
153417OtherMANAGED HEALTH NET
VT1007298Medicaid
VT249131OtherCOM PSYCH