Provider Demographics
NPI:1063600047
Name:JILL THISTLETHWAITE, PSYCHOLOGY, PC
Entity type:Organization
Organization Name:JILL THISTLETHWAITE, PSYCHOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:THISTLETHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-982-5247
Mailing Address - Street 1:144 E 7TH ST
Mailing Address - Street 2:SUITE C-12
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6203
Mailing Address - Country:US
Mailing Address - Phone:212-982-5247
Mailing Address - Fax:
Practice Address - Street 1:156 5TH AVE
Practice Address - Street 2:SUITE 720
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7002
Practice Address - Country:US
Practice Address - Phone:212-337-9596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007451103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01132934Medicaid
NY01132934Medicaid