Provider Demographics
NPI:1629307517
Name:JACKOWSKI, JILL M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:JACKOWSKI
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 1:2900 HEMPSTEAD TPKE
Mailing Address - Street 2:217
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1404
Mailing Address - Country:US
Mailing Address - Phone:516-508-8107
Mailing Address - Fax:
Practice Address - Street 1:2900 HEMPSTEAD TPKE
Practice Address - Street 2:217
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1404
Practice Address - Country:US
Practice Address - Phone:516-508-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health