Provider Demographics
NPI:1669514758
Name:CAFFREY, JILL TERESA (PHD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:TERESA
Last Name:CAFFREY
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 1:403 W COOL DR STE 107
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6551
Mailing Address - Country:US
Mailing Address - Phone:520-329-8298
Mailing Address - Fax:520-329-8311
Practice Address - Street 1:403 W COOL DR STE 107
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-329-8298
Practice Address - Fax:520-329-8311
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2023103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00646501OtherMEDICARE RAILROAD
AZ186644Medicaid
AZ5385585OtherAETNA
AZ236799OtherMANAGED HEALTH NETWORK
AZ186644Medicaid
AZR61392Medicare UPIN