Provider Demographics
NPI:1710062435
Name:HOLMGREN, JILL ELLIOTT (MSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELLIOTT
Last Name:HOLMGREN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118
Mailing Address - Country:US
Mailing Address - Phone:860-519-1943
Mailing Address - Fax:
Practice Address - Street 1:7 VAUXHALL STREET
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-442-2797
Practice Address - Fax:860-701-3776
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker