Provider Demographics
NPI:1568084234
Name:RATHUS, JILL H (PHD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:H
Last Name:RATHUS
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 1:60 CUTTERMILL RD STE 404
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3104
Mailing Address - Country:US
Mailing Address - Phone:516-858-4328
Mailing Address - Fax:
Practice Address - Street 1:60 CUTTERMILL RD STE 404
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3104
Practice Address - Country:US
Practice Address - Phone:516-858-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical