Provider Demographics
NPI:1811299712
Name:VALLE, JILL E (LMHC, LMFT)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:E
Last Name:VALLE
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 CANTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2417
Mailing Address - Country:US
Mailing Address - Phone:310-500-6907
Mailing Address - Fax:
Practice Address - Street 1:1330 CANTON AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-2417
Practice Address - Country:US
Practice Address - Phone:310-500-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-28
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7285101YM0800X
CA45581106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist