Provider Demographics
NPI:1669615134
Name:GLASHOW, JILL K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:K
Last Name:GLASHOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:K
Other - Last Name:KATEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:151 MYSTIC AVE
Mailing Address - Street 2:SUITE SIX
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4632
Mailing Address - Country:US
Mailing Address - Phone:781-396-1199
Mailing Address - Fax:781-396-1439
Practice Address - Street 1:151 MYSTIC AVE
Practice Address - Street 2:SUITE SIX
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4632
Practice Address - Country:US
Practice Address - Phone:781-396-1199
Practice Address - Fax:781-396-1439
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA2120801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical