Provider Demographics
NPI:1164648374
Name:RICHARDS, JILL MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DOGWOOD HL
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1948
Mailing Address - Country:US
Mailing Address - Phone:631-384-5211
Mailing Address - Fax:
Practice Address - Street 1:20 NASSAU ST
Practice Address - Street 2:SUITE 235A
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4509
Practice Address - Country:US
Practice Address - Phone:631-384-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014534-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist