Provider Demographics
NPI:1801130935
Name:WOOD, JILL S (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:S
Last Name:WOOD
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:S
Other - Last Name:RESNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6106 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9701
Mailing Address - Country:US
Mailing Address - Phone:609-645-7779
Mailing Address - Fax:
Practice Address - Street 1:6106 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9701
Practice Address - Country:US
Practice Address - Phone:609-645-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00160500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist