Provider Demographics
NPI:1518344282
Name:FAY, JILL (PSYD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 U ST NW
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-7991
Mailing Address - Country:US
Mailing Address - Phone:202-888-5595
Mailing Address - Fax:
Practice Address - Street 1:1330 U ST NW
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7991
Practice Address - Country:US
Practice Address - Phone:202-888-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000969103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist