Provider Demographics
NPI:1275501280
Name:PFITZENMAYER, JILL M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:PFITZENMAYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:218 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4063
Mailing Address - Country:US
Mailing Address - Phone:401-954-4978
Mailing Address - Fax:401-841-8841
Practice Address - Street 1:1090 NEW LONDON AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3035
Practice Address - Country:US
Practice Address - Phone:401-463-5778
Practice Address - Fax:401-463-3592
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00703103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS00703OtherLICENSE