Provider Demographics
NPI:1124289541
Name:DEPAUL, JILLIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:DEPAUL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W EXCHANGE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1000
Mailing Address - Country:US
Mailing Address - Phone:401-351-7779
Mailing Address - Fax:
Practice Address - Street 1:260 W EXCHANGE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1000
Practice Address - Country:US
Practice Address - Phone:401-351-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling