Provider Demographics
NPI:1427862978
Name:THERIAULT, JOCELYN ROSE
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ROSE
Last Name:THERIAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1974
Mailing Address - Country:US
Mailing Address - Phone:860-383-7090
Mailing Address - Fax:
Practice Address - Street 1:15 N MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1974
Practice Address - Country:US
Practice Address - Phone:860-383-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical