MEDICARE: MS. JILL E MILLEA L.P.C.

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	101YP2500X	Professional Counselor	001194

General Provider Information

NPI Number	:	1932153756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL E MILLEA L.P.C.

Provider Business Mailing Address
First Line	:	321 MAIN ST
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-5840
Country	:	US
Telephone Number	:	860-889-3178
Fax Number	:	860-823-3850

Provider Business Practice Location Address
First Line	:	46 LEBANON RD # 4A
Second Line	:
City	:	BOZRAH
State	:	CT
Zip	:	06334-1116
Country	:	US
Telephone Number	:	860-886-8122
Fax Number	:	860-535-9921

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/23/2019

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