Healthcare Provider Details

I. General information

NPI: 1720733421
Provider Name (Legal Business Name): JILL SHERMAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MOHEGAN AVE
STAMFORD CT
06902-7410
US

IV. Provider business mailing address

20 MOHEGAN AVE
STAMFORD CT
06902-7410
US

V. Phone/Fax

Practice location:
  • Phone: 203-883-2461
  • Fax:
Mailing address:
  • Phone: 203-883-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: