Provider Demographics
NPI:1205394202
Name:BUCHWALD, JILLIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:BUCHWALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-0226
Mailing Address - Country:US
Mailing Address - Phone:310-633-0052
Mailing Address - Fax:310-988-2680
Practice Address - Street 1:276 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4509
Practice Address - Country:US
Practice Address - Phone:310-633-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20748103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral