Provider Demographics
NPI:1184146227
Name:RICHROATH, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:RICHROATH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:VARRICCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 LLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-2611
Mailing Address - Country:US
Mailing Address - Phone:516-721-0033
Mailing Address - Fax:
Practice Address - Street 1:84 LLOYD AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2611
Practice Address - Country:US
Practice Address - Phone:516-721-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency