Provider Demographics
NPI:1336513092
Name:FIFE, JILL (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FIFE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W END AVE
Mailing Address - Street 2:APT. 9D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4345
Mailing Address - Country:US
Mailing Address - Phone:914-715-6952
Mailing Address - Fax:
Practice Address - Street 1:585 N BARRY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1633
Practice Address - Country:US
Practice Address - Phone:914-715-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0795711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical