Provider Demographics
NPI:1487816377
Name:ENGERMAN, JILL STEELE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:STEELE
Last Name:ENGERMAN
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 1:40 CRESCENT ST
Mailing Address - Street 2:205
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 2:205
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:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1144241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical