Provider Demographics
NPI:1568058089
Name:WORRALL, JILL DONNA (LSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DONNA
Last Name:WORRALL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MYERS AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2148
Mailing Address - Country:US
Mailing Address - Phone:973-223-3435
Mailing Address - Fax:
Practice Address - Street 1:4 2ND AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2758
Practice Address - Country:US
Practice Address - Phone:973-263-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ44SL06267600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL062667600OtherNJ BOARD OF SOCIAL WORK EXAMINERS