Provider Demographics
NPI:1275940561
Name:FILCOFF, JENNIFER SHANNON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SHANNON
Last Name:FILCOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENI
Other - Middle Name:
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2500 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8549
Mailing Address - Country:US
Mailing Address - Phone:919-654-3004
Mailing Address - Fax:
Practice Address - Street 1:2500 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8549
Practice Address - Country:US
Practice Address - Phone:919-654-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY3805103TC1900X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling