Provider Demographics
NPI:1912262312
Name:MASTRANDREA, JILL (MHC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:MASTRANDREA
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 5TH AVE
Mailing Address - Street 2:8A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3005
Mailing Address - Country:US
Mailing Address - Phone:516-680-0096
Mailing Address - Fax:
Practice Address - Street 1:6207 WOODSIDE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3576
Practice Address - Country:US
Practice Address - Phone:718-898-5085
Practice Address - Fax:718-898-5582
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)