Provider Demographics
NPI:1508243502
Name:STILE, JILLIAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:M
Last Name:STILE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CENTRAL PARK W
Mailing Address - Street 2:SUITE 13E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3015
Mailing Address - Country:US
Mailing Address - Phone:917-975-3435
Mailing Address - Fax:
Practice Address - Street 1:275 CENTRAL PARK W
Practice Address - Street 2:SUITE 13E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3015
Practice Address - Country:US
Practice Address - Phone:917-975-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical