1265708630 NPI number — MRS. JILL OSBORNE NICHOLS FEEHAN LMSW

Table of content: MRS. JILL OSBORNE NICHOLS FEEHAN LMSW (NPI 1265708630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265708630 NPI number — MRS. JILL OSBORNE NICHOLS FEEHAN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS FEEHAN
Provider First Name:
JILL
Provider Middle Name:
OSBORNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265708630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 GIBSON RD.
Provider Second Line Business Mailing Address:
ORANGE ULSTER BOCES RAYMOND C. CRAMER SECONDARY
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-291-0200
Provider Business Mailing Address Fax Number:
845-291-0125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 GIBSON RD
Provider Second Line Business Practice Location Address:
ORANGE ULSTER BOCES RAYMOND C. CRAMER SECONDARY
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10924-6709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-291-0200
Provider Business Practice Location Address Fax Number:
845-291-0125
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041S0200X , with the licence number:  035136 1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0351361 . This is a "NEW YORK EDUCATION DEPARTMENT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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