Provider Demographics
NPI:1780964593
Name:CLOCKADALE, JILL (LMSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:CLOCKADALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WEST 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4936
Mailing Address - Country:US
Mailing Address - Phone:212-991-0003
Mailing Address - Fax:646-365-5730
Practice Address - Street 1:224 W 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4905
Practice Address - Country:US
Practice Address - Phone:212-991-0003
Practice Address - Fax:646-365-5730
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker