Provider Demographics
NPI:1740679877
Name:HODGE, JILL (LMSW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FAIRCHILD SQ
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1254
Mailing Address - Country:US
Mailing Address - Phone:518-664-5066
Mailing Address - Fax:518-664-5728
Practice Address - Street 1:4 FAIRCHILD SQ
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1254
Practice Address - Country:US
Practice Address - Phone:518-664-5066
Practice Address - Fax:518-664-5728
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055665-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker