Provider Demographics
NPI:1679662506
Name:KAISER, JILL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HALSTEAD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2742
Mailing Address - Country:US
Mailing Address - Phone:914-584-2058
Mailing Address - Fax:914-517-1332
Practice Address - Street 1:650 HALSTEAD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2742
Practice Address - Country:US
Practice Address - Phone:914-584-2058
Practice Address - Fax:914-517-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046342-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical