Provider Demographics
NPI:1033385562
Name:MARSHALL, JILL M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:MASSARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-1430
Mailing Address - Country:US
Mailing Address - Phone:415-986-4945
Mailing Address - Fax:415-402-0413
Practice Address - Street 1:4052 PEMBROKE LN
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-2411
Practice Address - Country:US
Practice Address - Phone:510-207-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1045731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical