Provider Demographics
NPI:1215007422
Name:EMANUELE, JILL M (PHD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:EMANUELE
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 1:520 W 43RD ST
Mailing Address - Street 2:APT. 19A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4304
Mailing Address - Country:US
Mailing Address - Phone:718-920-4653
Mailing Address - Fax:718-405-5953
Practice Address - Street 1:MMC - CHILD ANNEX
Practice Address - Street 2:3300 KOSSUTH AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-4653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015705103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist