Provider Demographics
NPI:1457700031
Name:ESPOSITO, JILLIAN MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:MARIE
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JILLIAN
Other - Middle Name:MARIE
Other - Last Name:ROQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:25 HANOVER ROAD
Mailing Address - Street 2:BUILDING B SUITE 120
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:973-865-8168
Mailing Address - Fax:
Practice Address - Street 1:25 HANOVER ROAD
Practice Address - Street 2:BUILDING B SUITE 120
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-865-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05789600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker