Provider Demographics
NPI:1679989867
Name:CAWLEY, JILLIAN (MS, NCSP, BCBA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:CAWLEY
Suffix:
Gender:F
Credentials:MS, NCSP, BCBA
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:HABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCSP, BCBA
Mailing Address - Street 1:13609 68TH DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1619
Mailing Address - Country:US
Mailing Address - Phone:914-799-0129
Mailing Address - Fax:
Practice Address - Street 1:13609 68TH DR
Practice Address - Street 2:UNIT A
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-1619
Practice Address - Country:US
Practice Address - Phone:914-799-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1092165103TS0200X
1-09-6349103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool