Individual
LILLY JAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
950 DANBY RD, ITHACA, NY 14850-5778
(607) 260-3100
Mailing address
950 DANBY RD, ITHACA, NY 14850-5778
(607) 260-3100
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
025190
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/11/2020
Last updated
08/22/2023
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