Provider Demographics
NPI:1093018020
Name:EICHER, JILL (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:EICHER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 EMORY RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-4017
Mailing Address - Country:US
Mailing Address - Phone:443-825-7842
Mailing Address - Fax:
Practice Address - Street 1:2015 EMORY RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-4017
Practice Address - Country:US
Practice Address - Phone:667-444-2330
Practice Address - Fax:410-848-1980
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG11978104100000X
MD178131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD941012100Medicaid