Provider Demographics
NPI:1841819729
Name:PANICO, JILL KAREN
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:KAREN
Last Name:PANICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 ROUTE 202 STE 320
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2737
Mailing Address - Country:US
Mailing Address - Phone:908-507-1330
Mailing Address - Fax:
Practice Address - Street 1:17 CRAIG RD
Practice Address - Street 2:
Practice Address - City:NESHANIC STATION
Practice Address - State:NJ
Practice Address - Zip Code:08853-3506
Practice Address - Country:US
Practice Address - Phone:908-782-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
44SLO5760200104100000X
NJ37LC00284900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker