Provider Demographics
NPI:1629152954
Name:MUSHKAT CONOMY, JILL HELENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:HELENE
Last Name:MUSHKAT CONOMY
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 1:6803 MAYFIELD RD. #200
Mailing Address - Street 2:CCF HILLCREST HOSP. PAIN CENTER
Mailing Address - City:MAYFIELD HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:216-491-6314
Mailing Address - Fax:440-312-8434
Practice Address - Street 1:6803 MAYFIELD RD. #200
Practice Address - Street 2:CCHSEAST HILLCREST HOSP. PAIN CENTER
Practice Address - City:MAYFIELD HTS.
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:216-491-6314
Practice Address - Fax:440-312-8434
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2945103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0425123Medicaid
OHMUCP17153Medicare ID - Type Unspecified
OH0425123Medicaid