Provider Demographics
NPI:1356863054
Name:SVRJCEK, JILL ALLEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ALLEN
Last Name:SVRJCEK
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 1:1204 CONSTANTINE CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-6838
Mailing Address - Country:US
Mailing Address - Phone:410-688-7671
Mailing Address - Fax:
Practice Address - Street 1:1201 AGORA DR STE LB2
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-6863
Practice Address - Country:US
Practice Address - Phone:410-836-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD040061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical