Provider Demographics
NPI:1285025072
Name:LATTERI, JILL (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LATTERI
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 1:1201 AGORA DR
Mailing Address - Street 2:SUITE LB-2
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-6859
Mailing Address - Country:US
Mailing Address - Phone:410-836-7332
Mailing Address - Fax:410-836-7422
Practice Address - Street 1:204 E JOPPA RD
Practice Address - Street 2:803
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3118
Practice Address - Country:US
Practice Address - Phone:425-246-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD186831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical