Provider Demographics
NPI:1962623264
Name:BAINBRIDGE, JILL (MED)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 GEARY WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-8804
Mailing Address - Country:US
Mailing Address - Phone:570-617-8564
Mailing Address - Fax:
Practice Address - Street 1:2101 N FRONT ST
Practice Address - Street 2:BLDG. 1 SUITE 300
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1086
Practice Address - Country:US
Practice Address - Phone:717-635-2574
Practice Address - Fax:717-635-7167
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor