Provider Demographics
NPI:1093174104
Name:SCHLOSSBERG, JILL MARIE (LCADC, LAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:SCHLOSSBERG
Suffix:
Gender:F
Credentials:LCADC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 WASHINGTON ST
Mailing Address - Street 2:APT 3
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4982
Mailing Address - Country:US
Mailing Address - Phone:201-835-6663
Mailing Address - Fax:
Practice Address - Street 1:416 WASHINGTON ST
Practice Address - Street 2:APT 3
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4982
Practice Address - Country:US
Practice Address - Phone:201-835-6663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00202700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)