MEDICARE: JILLIAN ALEXANDRIA TUSCHHOFF LCSW

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	1041C0700X	Clinical Social Worker	10842	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386162105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN ALEXANDRIA TUSCHHOFF LCSW

Provider Business Mailing Address
First Line	:	400 COLUMBUS AVENUE
Second Line	:	CREDENTIALING SPECIALIST
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-1233
Country	:	US
Telephone Number	:	203-503-3376
Fax Number	:	203-503-3370

Provider Business Practice Location Address
First Line	:	62 GRANT STREET
Second Line	:	GRANT STREET PARTNERSHIP
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-3456
Country	:	US
Telephone Number	:	203-503-3350
Fax Number	:	203-503-3370

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

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	11/05/2019

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