Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 023061 | NY |
Y | 103T00000X | Psychologist | 023061 | NY |
N | 103TS0200X | School Psychologist | 0813000934 | VA |
NPI | 1063914687 |
---|---|
Provider Name | Dr. Jilynn Eagen |
First Address | West Seneca, NY 14224-3698 |
Second Address | West Seneca, NY 14224-3698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 27/08/2019 |