Provider Demographics
NPI:1265539555
Name:HILL, JANE YOUNG (LCSW, DCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:YOUNG
Last Name:HILL
Suffix:
Gender:F
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 MARSH LANDING BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1287
Mailing Address - Country:US
Mailing Address - Phone:904-280-3344
Mailing Address - Fax:904-212-1903
Practice Address - Street 1:4400 MARSH LANDING BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1287
Practice Address - Country:US
Practice Address - Phone:904-280-3344
Practice Address - Fax:904-212-1903
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 57381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000849147Medicare UPIN
FLZ0293Medicare ID - Type Unspecified