Jill Talbot
Individual provider Active NPI Marriage & Family Therapist · Riverside, CT
NPI 1962242594 · NPPES record last updated May 30, 2024
Key facts
- NPI
- 1962242594
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 3396 (CT)
- Practice address
- 36 Lake Dr S
Riverside, CT 06878-2024 - Phone
- (312) 405-0140
- NPI assigned
- May 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3396 | CT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimal Outcomes Therapy PLLC | Marriage & Family Therapist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 3396 | CT | Yes |
Addresses
Primary practice location
36 Lake Dr S
Riverside, CT 06878-2024
Mailing address
36 Lake Dr S
Riverside, CT 06878-2024
Phone (312) 405-0140
Other providers in Riverside, CT
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- Renee Sheppard
- Breanne Siman
- Alex Soltren
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- Bruce Robert Turton
- Jillian Vai
- Bozena Valencic
- Zena Vatman
All providers in Riverside, CT · Marriage & Family Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.