Provider Demographics
NPI:1508202342
Name:KILBRIDE, JESSICA ELIZABETH (LCSW, MSN, PMHNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:KILBRIDE
Suffix:
Gender:F
Credentials:LCSW, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 DOBBS FERRY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1912
Mailing Address - Country:US
Mailing Address - Phone:914-372-6833
Mailing Address - Fax:
Practice Address - Street 1:280 DOBBS FERRY RD STE 205
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1912
Practice Address - Country:US
Practice Address - Phone:914-372-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 088144104100000X
NY760350163WP0808X
NY402992363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health