Provider Demographics
NPI:1750811717
Name:EGAN, JILLIAN MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARIE
Last Name:EGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S JOYCE ST APT 133
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-5103
Mailing Address - Country:US
Mailing Address - Phone:609-306-3826
Mailing Address - Fax:
Practice Address - Street 1:1321 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3311
Practice Address - Country:US
Practice Address - Phone:202-333-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005029103TC0700X
MD05281103TC0700X
DCPSY1000895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical