Provider Demographics
NPI:1508205584
Name:SCHREIDER, JILL MEREDITH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MEREDITH
Last Name:SCHREIDER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:MEREDITH
Other - Last Name:SCHREIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1218 VFW PKWY APT 50
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4326
Mailing Address - Country:US
Mailing Address - Phone:508-479-9482
Mailing Address - Fax:
Practice Address - Street 1:971 CONCORD ST STE 7
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4689
Practice Address - Country:US
Practice Address - Phone:508-479-9482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1201551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA120155OtherBOARD OF SOCIAL WORKERS
MA120155OtherCOMMONWEALTH OF MASSACHUSETTS