Healthcare Provider Details

I. General information

NPI: 1134322894
Provider Name (Legal Business Name): JIL MARIE WHITTLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 OLANDWOOD CT STE. 201
OLNEY MD
20832-1372
US

IV. Provider business mailing address

14417 BAKERSFIELD CT
SILVER SPRING MD
20906-1949
US

V. Phone/Fax

Practice location:
  • Phone: 240-475-0143
  • Fax:
Mailing address:
  • Phone: 301-443-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07261
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50077916
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: