Provider Demographics
NPI:1659052298
Name:TRILLER, RENEE ELIZABETH AGNES (LPCA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ELIZABETH AGNES
Last Name:TRILLER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 WASHINGTON ST # WE22
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2948
Mailing Address - Country:US
Mailing Address - Phone:802-855-3966
Mailing Address - Fax:
Practice Address - Street 1:8 W MAIN ST STE 3-15
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-2332
Practice Address - Country:US
Practice Address - Phone:860-316-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional