Provider Demographics
NPI:1497108815
Name:SUKENICK, JILL I (MSW, PHD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SUKENICK
Suffix:I
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E 84TH ST
Mailing Address - Street 2:APT 5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0919
Mailing Address - Country:US
Mailing Address - Phone:212-872-1530
Mailing Address - Fax:
Practice Address - Street 1:120 E 62ND ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8149
Practice Address - Country:US
Practice Address - Phone:212-872-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0254781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical