Provider Demographics
NPI:1821976671
Name:JACQUEMIN, TAYLOR (LPC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:JACQUEMIN
Suffix:
Gender:X
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MATTHEWS ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-8512
Mailing Address - Country:US
Mailing Address - Phone:860-416-0040
Mailing Address - Fax:
Practice Address - Street 1:55 WINTHROP ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1728
Practice Address - Country:US
Practice Address - Phone:860-253-2139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional