Provider Demographics
NPI:1710467998
Name:BLASZKOWSKY, JILL SUZANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:BLASZKOWSKY
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 1:53 WINFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1860
Mailing Address - Country:US
Mailing Address - Phone:781-405-7592
Mailing Address - Fax:
Practice Address - Street 1:CAMPION CENTER
Practice Address - Street 2:319 CONCORD ROAD
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493
Practice Address - Country:US
Practice Address - Phone:781-788-6832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical