Provider Demographics
NPI:1174278212
Name:JENKINS, JILL (PSYD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 AVIS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2650
Mailing Address - Country:US
Mailing Address - Phone:518-560-4277
Mailing Address - Fax:518-662-4277
Practice Address - Street 1:4 AVIS DR STE 101
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2650
Practice Address - Country:US
Practice Address - Phone:518-560-4277
Practice Address - Fax:518-662-4277
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024413103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist