Healthcare Provider Details

I. General information

NPI: 1124289541
Provider Name (Legal Business Name): JILLIAN DEPAUL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W EXCHANGE ST SUITE 210
PROVIDENCE RI
02903-1000
US

IV. Provider business mailing address

260 W EXCHANGE ST SUITE 210
PROVIDENCE RI
02903-1000
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-7779
  • Fax:
Mailing address:
  • Phone: 401-351-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: