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General NPI Number Information
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NPI Number | 1063600047
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Entity Type | Organization
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Legal Business Name | JILL THISTLETHWAITE, PSYCHOLOGY, PC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 156 5TH AVE SUITE 720
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City | NEW YORK
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State | NY
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Zip | 10010-7002
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Country | US
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Telephone | 212-337-9596
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Fax |
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Provider Business Mailing Address
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Address Line | 144 E 7TH ST SUITE C-12
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City | NEW YORK
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State | NY
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Zip | 10009-6203
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Country | US
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Telephone | 212-982-5247
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JILL THISTLETHWAITE
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Credential | PHD
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Telephone | 212-982-5247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 007451
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License Number State | NY
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