MEDICARE: MR. PETER ANDREW TALBOT LCSW NCPSY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	001877	CT

General Provider Information

NPI Number	:	1003999863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER ANDREW TALBOT LCSW NCPSY

Provider Business Mailing Address
First Line	:	57 PLAINS RD
Second Line	:	SUITE 1C
City	:	MILFORD
State	:	CT
Zip	:	06461-2573
Country	:	US
Telephone Number	:	203-494-6565
Fax Number	:	203-876-9911

Provider Business Practice Location Address
First Line	:	57 PLAINS RD
Second Line	:	SUITE 1C
City	:	MILFORD
State	:	CT
Zip	:	06461-2573
Country	:	US
Telephone Number	:	203-494-6565
Fax Number	:	203-876-9911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/29/2013

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