Healthcare Provider Details

I. General information

NPI: 1376877910
Provider Name (Legal Business Name): JILL MARIE MCCABE M.S.,LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 BALLSTON AVE
SARATOGA SPRINGS NY
12866-4723
US

IV. Provider business mailing address

PO BOX 889
ROUND LAKE NY
12151-0889
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-8241
  • Fax:
Mailing address:
  • Phone: 518-899-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004038
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: