Provider Demographics
NPI:1669799227
Name:HOLSTEIN, JILL C
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GROVE ST
Mailing Address - Street 2:PO BOX 218
Mailing Address - City:GLENWOOD LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:11547-3061
Mailing Address - Country:US
Mailing Address - Phone:516-376-3885
Mailing Address - Fax:631-946-6101
Practice Address - Street 1:53 GROVE ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD LANDING
Practice Address - State:NY
Practice Address - Zip Code:11547-3061
Practice Address - Country:US
Practice Address - Phone:516-376-3885
Practice Address - Fax:631-946-6101
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR059594-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical