Provider Demographics
NPI:1497394613
Name:CARUSO, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CARUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3016
Mailing Address - Street 2:
Mailing Address - City:SOUTH HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07606-1016
Mailing Address - Country:US
Mailing Address - Phone:201-488-6678
Mailing Address - Fax:201-342-4346
Practice Address - Street 1:4 FOREST AVE STE 110
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5214
Practice Address - Country:US
Practice Address - Phone:201-488-6678
Practice Address - Fax:201-342-4346
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTP-173-043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical