Provider Demographics
NPI:1952953523
Name:MCCULLOCH, JILL (PHD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:BETH
Other - Last Name:ROMANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7910 WOODMONT AVE STE 1101
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7059
Mailing Address - Country:US
Mailing Address - Phone:301-221-1591
Mailing Address - Fax:
Practice Address - Street 1:7910 WOODMONT AVE STE 1101
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7059
Practice Address - Country:US
Practice Address - Phone:202-486-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04555103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty