Jill D Shalan, PH.D. CLINICAL PSYCH

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002308 Issued in CT

Practice address

40 Dale Road
Suite 201
Avon, CT 06001

Phone

(860) 676-9350

Fax

(860) 678-7178

NPI assigned

Nov 20, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jill.shalan@ctproviderdirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jill Shalan, PHD, PLLC

  • Clinical Psychologist
  • West Hartford, CT
  • NPI 1235646316
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1881922326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 DALE ROAD",
            "address_2": "SUITE 201",
            "city": "AVON",
            "state": "CT",
            "postal_code": "06001",
            "telephone_number": "860-676-9350",
            "fax_number": "860-678-7178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 DALE ROAD",
            "address_2": "SUITE 201",
            "city": "AVON",
            "state": "CT",
            "postal_code": "06001",
            "telephone_number": "860-676-9350",
            "fax_number": "860-678-7178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHALAN",
        "first_name": "JILL",
        "middle_name": "D",
        "credential": "PH.D. CLINICAL PSYCH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-20",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "002308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn A Seifert, MOTR/L
• Agnieszka Seraphin
• Serene Therapy LLC
• Ted Scott Sewitch, PHD CLINICAL PSYCHOL
• Pari Shah, OD
• Eileen Sharp, APRN
• Marilyn Sharpe, OTR
• Michael D. Shea, APRN-BC
• Lisa Sheehan, PA-C
• Duojia Shen, APRN

• Clinical Psychologist in Avon, CT
• Providers in Avon, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.