Healthcare Provider Details

I. General information

NPI: 1265550800
Provider Name (Legal Business Name): THEA SCHILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BERKSHIRE RD
SANDY HOOK CT
06482-1361
US

IV. Provider business mailing address

15 BERKSHIRE RD
SANDY HOOK CT
06482-1361
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-8103
  • Fax: 203-426-0550
Mailing address:
  • Phone: 203-426-8103
  • Fax: 203-426-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC-5466
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001575
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: