Provider Demographics
NPI:1659500577
Name:SHILOH CONSULTING LLC
Entity Type:Organization
Organization Name:SHILOH CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:212-564-7631
Mailing Address - Street 1:566 7TH AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1802
Mailing Address - Country:US
Mailing Address - Phone:212-564-7631
Mailing Address - Fax:212-564-7819
Practice Address - Street 1:566 7TH AVE FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1802
Practice Address - Country:US
Practice Address - Phone:212-564-7631
Practice Address - Fax:212-564-7819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012747-1103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02966163Medicaid
NY02966163Medicaid