Provider Demographics
NPI:1013960491
Name:BURNS, JILL MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-0091
Mailing Address - Country:US
Mailing Address - Phone:973-764-4304
Mailing Address - Fax:
Practice Address - Street 1:78 ROUTE 23 N
Practice Address - Street 2:SUITE 2
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-1418
Practice Address - Country:US
Practice Address - Phone:973-209-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052740001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical