Provider Demographics
NPI:1275733289
Name:HARRELL, JILLIAN ELIZABETH (ASW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:HARRELL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ELIZABETH
Other - Last Name:PRIGMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 PEPPER TREE LN APT 314
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5279
Mailing Address - Country:US
Mailing Address - Phone:408-454-4300
Mailing Address - Fax:
Practice Address - Street 1:210 N. FOURTH ST, SUITE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-295-5288
Practice Address - Fax:408-292-1029
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22004104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker