Provider Demographics
NPI:1316370117
Name:JILL S ENGERMAN PSYCHOTHERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JILL S ENGERMAN PSYCHOTHERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:STEELE
Authorized Official - Last Name:ENGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-505-2779
Mailing Address - Street 1:40 CRESCENT ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4313
Mailing Address - Country:US
Mailing Address - Phone:978-505-2779
Mailing Address - Fax:
Practice Address - Street 1:40 CRESCENT ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4313
Practice Address - Country:US
Practice Address - Phone:978-505-2779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1144241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty