Provider Demographics
NPI:1801199583
Name:JILL N BAILLIO
Entity Type:Organization
Organization Name:JILL N BAILLIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:N
Authorized Official - Last Name:BAILLIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-294-0577
Mailing Address - Street 1:PO BOX 16310
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-6310
Mailing Address - Country:US
Mailing Address - Phone:813-294-0577
Mailing Address - Fax:910-794-4531
Practice Address - Street 1:205 S 5TH AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4549
Practice Address - Country:US
Practice Address - Phone:813-294-0577
Practice Address - Fax:910-794-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty