Provider Demographics
NPI:1952511446
Name:RIERDAN, JILL ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ELIZABETH
Last Name:RIERDAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-1013
Mailing Address - Country:US
Mailing Address - Phone:413-628-3399
Mailing Address - Fax:413-628-3399
Practice Address - Street 1:1277 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:ASHFIELD
Practice Address - State:MA
Practice Address - Zip Code:01330
Practice Address - Country:US
Practice Address - Phone:413-628-3399
Practice Address - Fax:413-628-3399
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical