Provider Demographics
NPI:1366689531
Name:SOLIVAN, JILLIAN (LICSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SOLIVAN
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 1:3 DUNDEE PARK
Mailing Address - Street 2:203 GENERAL PSYCHOLOGICAL ASSC
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-475-3590
Mailing Address - Fax:978-475-7620
Practice Address - Street 1:3 DUNDEE PARK DR
Practice Address - Street 2:203
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3751
Practice Address - Country:US
Practice Address - Phone:978-475-3590
Practice Address - Fax:978-475-7620
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1134061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical