Provider Demographics
NPI:1164914602
Name:YEDID, JILLIAN MICHELE (LMHC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MICHELE
Last Name:YEDID
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W AMES CT
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2304
Mailing Address - Country:US
Mailing Address - Phone:516-660-0651
Mailing Address - Fax:
Practice Address - Street 1:55 W AMES CT
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2304
Practice Address - Country:US
Practice Address - Phone:516-660-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP01229101YM0800X
NY009148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health