Provider Demographics
NPI:1760766422
Name:WUONOLA, JILL EVANS (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:EVANS
Last Name:WUONOLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:ELAINE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:95 PLEASANT ST
Mailing Address - Street 2:#52
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1524
Mailing Address - Country:US
Mailing Address - Phone:781-581-4448
Mailing Address - Fax:781-596-9992
Practice Address - Street 1:95 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1524
Practice Address - Country:US
Practice Address - Phone:781-581-4448
Practice Address - Fax:781-596-9992
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health