Provider Demographics
NPI:1740455237
Name:SWENSEN, JILL H (PHD,LMHC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:H
Last Name:SWENSEN
Suffix:
Gender:F
Credentials:PHD,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 YACHT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-4511
Mailing Address - Country:US
Mailing Address - Phone:516-459-3881
Mailing Address - Fax:
Practice Address - Street 1:69 YACHT CLUB RD
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-4511
Practice Address - Country:US
Practice Address - Phone:516-459-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000891-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health