Provider Demographics
NPI:1861561326
Name:NEILL, JEAN M (PHD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:NEILL
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 1:8340 AUBURN BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0389
Mailing Address - Country:US
Mailing Address - Phone:916-771-2425
Mailing Address - Fax:916-771-2425
Practice Address - Street 1:8340 AUBURN BLVD STE 150
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0389
Practice Address - Country:US
Practice Address - Phone:916-771-2425
Practice Address - Fax:916-771-2425
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL158950Medicare ID - Type UnspecifiedPSYCHOLOGIST