Provider Demographics
NPI:1740686237
Name:QUILTY, JILLIAN (LSW)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:QUILTY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5946
Mailing Address - Country:US
Mailing Address - Phone:732-996-1661
Mailing Address - Fax:
Practice Address - Street 1:308 SPRUCE DR
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-5946
Practice Address - Country:US
Practice Address - Phone:732-996-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05982400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker