Provider Demographics
NPI:1073772786
Name:CODY, JILL B (MA)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:B
Last Name:CODY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4305
Mailing Address - Country:US
Mailing Address - Phone:301-662-2266
Mailing Address - Fax:301-662-4448
Practice Address - Street 1:186 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4305
Practice Address - Country:US
Practice Address - Phone:301-662-2266
Practice Address - Fax:301-662-4448
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health