Provider Demographics
NPI:1003894205
Name:EKLUND, JILL LESLIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:LESLIE
Last Name:EKLUND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3665
Mailing Address - Country:US
Mailing Address - Phone:508-990-0852
Mailing Address - Fax:508-990-4777
Practice Address - Street 1:333 UNION ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3665
Practice Address - Country:US
Practice Address - Phone:508-990-0852
Practice Address - Fax:508-990-4777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10255061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P08040OtherBC/BS
MA540134Medicaid
7971534OtherAETNA
P20152Medicare UPIN
P08040OtherBC/BS