Basic Information
| Provider Information | |||||||||
| NPI: | 1326548389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EFFRON | ||||||||
| FirstName: | JILL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1151 E HECTOR ST APT 421 | ||||||||
| Address2: | |||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194280038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164079686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3401 CIVIC CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155901000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2018 | ||||||||
| LastUpdateDate: | 05/09/2018 | ||||||||
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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 | 163WP0808X | RN.431055 | OH | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0808X | RN702769 | PA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | SP018701 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.