Provider Demographics
NPI:1558730101
Name:EGBERT, JILL C (LICSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:EGBERT
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 1:6265 RTE 7A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05250-8434
Mailing Address - Country:US
Mailing Address - Phone:802-855-1427
Mailing Address - Fax:
Practice Address - Street 1:6265 RTE 7A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05250-8434
Practice Address - Country:US
Practice Address - Phone:802-855-1427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-01130941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical