Provider Demographics
NPI:1720144538
Name:PAKNIA, JILL MEYERS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MEYERS
Last Name:PAKNIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:MIRIAM
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:202 GOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-2326
Mailing Address - Country:US
Mailing Address - Phone:203-998-5279
Mailing Address - Fax:866-585-4617
Practice Address - Street 1:91 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5020
Practice Address - Country:US
Practice Address - Phone:203-998-5279
Practice Address - Fax:866-585-4617
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04173411041C0700X
CT0063291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300000134Medicare PIN