Provider Demographics
NPI:1245292267
Name:CAMM, JILL MARIE (LCSWC MSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:CAMM
Suffix:
Gender:F
Credentials:LCSWC MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENWAY ST NW STE 5
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3557
Mailing Address - Country:US
Mailing Address - Phone:410-760-9079
Mailing Address - Fax:410-760-1121
Practice Address - Street 1:30 GREENWAY ST NW STE 5
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3557
Practice Address - Country:US
Practice Address - Phone:410-760-9079
Practice Address - Fax:410-760-1121
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD074691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
513263OtherNCPPO INNOVA MHIP
0001OtherBLUE SHIELD FEDERAL
522229157OtherPHCS
155621OtherVALUE OPTIONS AND GREAT W
10761817OtherCAQH
5211595OtherAETNA BEHAVIORAL HEALTH
175115OtherMHN AND TRICARE
355594OtherMAMSI UNITED HEALTH CARE
60366205OtherBLUE SHIELD OF MD
230012000OtherMAGELLAN BEHAVIORAL HEALT
S003OtherBLUE SHIELD FEDERAL GROUP
0001OtherBLUE SHIELD FEDERAL
100025884OtherAPS
522229157OtherPHCS