Basic Information
| Provider Information | |||||||||
| NPI: | 1184026726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORNER | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSWR | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1176 | ||||||||
| Address2: | |||||||||
| City: | PORT EWEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124661176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453398707 | ||||||||
| FaxNumber: | 8453398740 | ||||||||
| Practice Location | |||||||||
| Address1: | 319 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | PORT EWEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124665501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453398707 | ||||||||
| FaxNumber: | 8453398740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2014 | ||||||||
| LastUpdateDate: | 09/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R050436-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.