| Jeremy Edward Driscoll | |
|
150 Sycamore Dr Torrington CT 06790-4262 | |
| (860) 309-7034 | |
| Not Available |
| Full Name | Jeremy Edward Driscoll |
|---|---|
| Speciality | Clinic/Center |
| Location | 150 Sycamore Dr, Torrington, Connecticut |
| Authorized Official Name and Position | Jeremy Edward Driscoll (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 8603097034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeremy Edward Driscoll 150 Sycamore Dr Torrington CT 06790-4262 Ph: (860) 309-7034 | Jeremy Edward Driscoll 150 Sycamore Dr Torrington CT 06790-4262 Ph: (860) 309-7034 |
| NPI Number | 1841684164 |
|---|---|
| Provider Enumeration Date | 03/25/2015 |
| Last Update Date | 04/17/2015 |
| Medicare PECOS PAC ID | 7719205012 |
|---|---|
| Medicare Enrollment ID | O20150417000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841684164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 000209 (Connecticut) | Primary |
| Provider Name | Jeremy Edward Driscoll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609919810 PECOS PAC ID: 8628396926 Enrollment ID: I20150504000519 |
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