Provider Demographics
NPI:1003999863
Name:TALBOT, PETER ANDREW (LCSW NCPSY)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ANDREW
Last Name:TALBOT
Suffix:
Gender:M
Credentials:LCSW NCPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PLAINS RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2573
Mailing Address - Country:US
Mailing Address - Phone:203-494-6565
Mailing Address - Fax:203-876-9911
Practice Address - Street 1:57 PLAINS RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2573
Practice Address - Country:US
Practice Address - Phone:203-494-6565
Practice Address - Fax:203-876-9911
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800001299Medicare ID - Type Unspecified