MEDICARE: MS. JILLIAN C CEA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1366011801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILLIAN C CEA

Provider Business Mailing Address
First Line	:	44 HAWKINS ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 HAWKINS ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1415
Country	:	US
Telephone Number	:	347-419-1222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2021
Last Update Date	:	06/20/2021

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