Provider Demographics
NPI:1770851701
Name:KAHN, JILLIEN ANNE (LMFT, MED, CST)
Entity Type:Individual
Prefix:
First Name:JILLIEN
Middle Name:ANNE
Last Name:KAHN
Suffix:
Gender:F
Credentials:LMFT, MED, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LAFAYETTE ST RM 501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4116
Mailing Address - Country:US
Mailing Address - Phone:360-689-4031
Mailing Address - Fax:
Practice Address - Street 1:110 LAFAYETTE ST RM 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4116
Practice Address - Country:US
Practice Address - Phone:360-689-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0015351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty