Healthcare Provider Details

I. General information

NPI: 1518119544
Provider Name (Legal Business Name): JILL EDELSTEIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL MAXI SCHREIBMAN LCSW

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W VIEW DR
GHENT NY
12075-1618
US

IV. Provider business mailing address

107 W VIEW DR
GHENT NY
12075-1618
US

V. Phone/Fax

Practice location:
  • Phone: 917-570-5592
  • Fax:
Mailing address:
  • Phone: 917-570-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079413-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: