Provider Demographics
NPI:1104812205
Name:MARLAND, JILL ELLEN (LICSW MSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELLEN
Last Name:MARLAND
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROUNDHOUSE PLZ
Mailing Address - Street 2:STE 201
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4401
Mailing Address - Country:US
Mailing Address - Phone:413-586-3058
Mailing Address - Fax:
Practice Address - Street 1:1 ROUNDHOUSE PLZ
Practice Address - Street 2:STE 201
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4401
Practice Address - Country:US
Practice Address - Phone:413-586-3058
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10211271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1857444Medicaid
MA1857444Medicaid