Provider Demographics
NPI:1710059167
Name:TAYLOR, JOAN-ALICE (PT, PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JOAN-ALICE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT, PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2319
Mailing Address - Country:US
Mailing Address - Phone:860-667-2706
Mailing Address - Fax:
Practice Address - Street 1:9 ELMWOOD CT
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1401
Practice Address - Country:US
Practice Address - Phone:860-953-1204
Practice Address - Fax:860-953-1208
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT433101YP2500X
CT1617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080001617CT01OtherANTHEM BLUE CROSS
CT076564Medicare ID - Type Unspecified