Provider Demographics
NPI:1073683025
Name:BANGERT, JILL (LCSWC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BANGERT
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 MALLARD DR
Mailing Address - Street 2:209
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708
Mailing Address - Country:US
Mailing Address - Phone:301-776-9492
Mailing Address - Fax:301-625-0864
Practice Address - Street 1:9811 MALLARD DR
Practice Address - Street 2:SUITE 209
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:301-776-9492
Practice Address - Fax:301-625-0864
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD045491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical