Provider Demographics
NPI:1538285713
Name:GANN-BURLINGAME, JILL P (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:P
Last Name:GANN-BURLINGAME
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CATHEDRAL ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2616
Mailing Address - Country:US
Mailing Address - Phone:410-315-9350
Mailing Address - Fax:410-421-9135
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-315-9350
Practice Address - Fax:410-421-9135
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2161101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional