Provider Demographics
NPI:1265708630
Name:NICHOLS FEEHAN, JILL OSBORNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:OSBORNE
Last Name:NICHOLS FEEHAN
Suffix:
Gender:F
Credentials:LMSW
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:53 GIBSON RD.
Mailing Address - Street 2:ORANGE ULSTER BOCES RAYMOND C. CRAMER SECONDARY
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924
Mailing Address - Country:US
Mailing Address - Phone:845-291-0200
Mailing Address - Fax:845-291-0125
Practice Address - Street 1:53 GIBSON RD
Practice Address - Street 2:ORANGE ULSTER BOCES RAYMOND C. CRAMER SECONDARY
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6709
Practice Address - Country:US
Practice Address - Phone:845-291-0200
Practice Address - Fax:845-291-0125
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY035136 11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0351361OtherNEW YORK EDUCATION DEPARTMENT