Provider Demographics
NPI:1326180415
Name:DE LA HUNT, JILL (LICSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:DE LA HUNT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EDGARTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568
Mailing Address - Country:US
Mailing Address - Phone:508-693-7900
Mailing Address - Fax:508-696-0401
Practice Address - Street 1:111 EDGARTOWN ROAD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:508-696-0401
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1153861041C0700X
NH14741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical