Provider Demographics
NPI:1952566002
Name:ROFFMAN LEVINE, JILL MICHELLE (LICSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MICHELLE
Last Name:ROFFMAN LEVINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:29 MANTON RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1528
Mailing Address - Country:US
Mailing Address - Phone:339-440-0056
Mailing Address - Fax:
Practice Address - Street 1:162 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904
Practice Address - Country:US
Practice Address - Phone:978-750-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10251931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical