Provider Demographics
NPI:1255514832
Name:PURDY, JILL (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:PURDY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:GROSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1615 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5639
Mailing Address - Country:US
Mailing Address - Phone:443-709-2974
Mailing Address - Fax:800-785-3951
Practice Address - Street 1:1615 YORK RD STE 300
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5639
Practice Address - Country:US
Practice Address - Phone:443-709-2974
Practice Address - Fax:800-785-3951
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical