Healthcare Provider Details

I. General information

NPI: 1932153756
Provider Name (Legal Business Name): JILL E MILLEA L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 LEBANON RD # 4A
BOZRAH CT
06334-1116
US

IV. Provider business mailing address

321 MAIN ST
NORWICH CT
06360-5840
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-8122
  • Fax: 860-535-9921
Mailing address:
  • Phone: 860-889-3178
  • Fax: 860-823-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001194
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: