Provider Demographics
NPI:1700960283
Name:KRISTAL, JILL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:KRISTAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:KRISTAL FEUERSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4 ROCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3918
Mailing Address - Country:US
Mailing Address - Phone:914-835-2368
Mailing Address - Fax:
Practice Address - Street 1:2 MADISON AVE STE 201
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1961
Practice Address - Country:US
Practice Address - Phone:914-374-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical