Provider Demographics
NPI:1811294564
Name:JEWELL, JILL KRISTIN (EDM, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:KRISTIN
Last Name:JEWELL
Suffix:
Gender:F
Credentials:EDM, BCBA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:KRISTIN
Other - Last Name:PROCACCINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1825 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7536
Mailing Address - Country:US
Mailing Address - Phone:609-774-0978
Mailing Address - Fax:856-765-9081
Practice Address - Street 1:1825 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7536
Practice Address - Country:US
Practice Address - Phone:609-774-0978
Practice Address - Fax:856-765-9081
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-12921103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst