Jill Mirlis, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35S100704700 Issued in NJ

Practice address

122 High St
Passaic, NJ 07055-4753

Phone

(973) 930-1770

NPI assigned

Oct 11, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jill Bogard Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707523200000",
    "number": "1467050641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 HIGH ST",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554753",
            "telephone_number": "973-930-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 HIGH ST",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554753",
            "telephone_number": "973-930-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRLIS",
        "first_name": "JILL",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-11",
        "last_updated": "2024-02-10",
        "certification_date": "2024-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "026273",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35S100704700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "BOGARD",
            "credential": "MS.ED.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Lela Miloseska, PA-C
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• Rosalia S Molho, M.D.
• Zisi Monheit, PHARMD, B.C.P.S.

• Clinical Psychologist in Passaic, NJ
• Providers in Passaic, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.