Provider Demographics
NPI:1841332574
Name:FLEISCHNER, JILL GREG (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:GREG
Last Name:FLEISCHNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01375-9617
Mailing Address - Country:US
Mailing Address - Phone:413-552-7054
Mailing Address - Fax:
Practice Address - Street 1:110 N HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9726
Practice Address - Country:US
Practice Address - Phone:413-552-7054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10305611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
389753OtherBLUE CROSS
MA1893068Medicaid
P08489OtherBLUE CROSS
MA1893468OtherMASS HEALTH MBHP
MA354601OtherTUFTS
389753OtherMAGELLAN