Healthcare Provider Details

I. General information

NPI: 1871466094
Provider Name (Legal Business Name): JAQUELYN TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 UNQUOWA RD
FAIRFIELD CT
06824-5059
US

IV. Provider business mailing address

16 SAYBROOK RD
ESSEX CT
06426-1401
US

V. Phone/Fax

Practice location:
  • Phone: 203-592-5836
  • Fax:
Mailing address:
  • Phone: 203-592-5836
  • Fax: 866-706-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number015529
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: