Provider Demographics
NPI:1336536341
Name:BEALE, JILLIAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:M
Last Name:BEALE
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 1:36 OLD KINGS HWY S STE 200
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4523
Mailing Address - Country:US
Mailing Address - Phone:203-231-2333
Mailing Address - Fax:
Practice Address - Street 1:36 OLD KINGS HWY S STE 200
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4523
Practice Address - Country:US
Practice Address - Phone:203-231-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT102491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical