MEDICARE: MS. JILL MOUNT LONGSHORE LISW-CP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6417	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346423522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL MOUNT LONGSHORE LISW-CP

Provider Business Mailing Address
First Line	:	338 W COLUMBIA AVE
Second Line	:
City	:	BATESBURG LEESVILLE
State	:	SC
Zip	:	29006-2028
Country	:	US
Telephone Number	:	803-532-4423
Fax Number	:	803-532-8000

Provider Business Practice Location Address
First Line	:	338 W COLUMBIA AVE
Second Line	:
City	:	BATESBURG LEESVILLE
State	:	SC
Zip	:	29006-2028
Country	:	US
Telephone Number	:	803-532-4423
Fax Number	:	803-532-8000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	05/11/2023

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