Provider Demographics
NPI:1821587809
Name:NYDAM, JILL (LPC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:NYDAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DEER RUN LN
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4390
Mailing Address - Country:US
Mailing Address - Phone:848-448-0416
Mailing Address - Fax:
Practice Address - Street 1:30 DEER RUN LN
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-4390
Practice Address - Country:US
Practice Address - Phone:848-448-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00605100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional