Provider Demographics
NPI:1376352658
Name:GRANOFF, JILL VARADY (PHD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:VARADY
Last Name:GRANOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:VARADY
Other - Last Name:REAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 N ASHLAND AVE UNIT 214
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-5222
Mailing Address - Country:US
Mailing Address - Phone:312-841-0593
Mailing Address - Fax:
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-8397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5301-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical