Provider Demographics
NPI:1457632549
Name:GUGGENHEIM, JILL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:GUGGENHEIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E 33RD ST
Mailing Address - Street 2:SUITE 31J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4874
Mailing Address - Country:US
Mailing Address - Phone:212-725-0192
Mailing Address - Fax:914-285-5723
Practice Address - Street 1:200 E 33RD ST
Practice Address - Street 2:SUITE 31J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4874
Practice Address - Country:US
Practice Address - Phone:212-725-0192
Practice Address - Fax:914-285-5723
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019049103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical