Provider Demographics
NPI:1043572456
Name:JILLY'S PLACE
Entity Type:Organization
Organization Name:JILLY'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN , LMSW
Authorized Official - Phone:845-496-1966
Mailing Address - Street 1:10 WEATHERVANE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-2242
Mailing Address - Country:US
Mailing Address - Phone:845-496-1966
Mailing Address - Fax:845-496-1976
Practice Address - Street 1:10 WEATHERVANE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-2242
Practice Address - Country:US
Practice Address - Phone:845-496-1966
Practice Address - Fax:845-496-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency