Provider Demographics
NPI:1033392923
Name:DEVITT, JILL SCOTT (LICSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SCOTT
Last Name:DEVITT
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 1:395 TOTTEN POND RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-2007
Mailing Address - Country:US
Mailing Address - Phone:857-373-9337
Mailing Address - Fax:
Practice Address - Street 1:395 TOTTEN POND RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-2007
Practice Address - Country:US
Practice Address - Phone:857-373-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10269531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08739OtherBLUE CROSS BLUE SHIELD