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General NPI Number Information
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NPI Number | 1164881728
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Entity Type | Individual
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Provider Name | JILL MAIORCA LISW
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Gender | Female
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 8140 AUBURN RD
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City | CONCORD TWP
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State | OH
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Zip | 44077-9179
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Country | US
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Telephone | 440-479-3441
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Fax |
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Provider Business Mailing Address
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Address Line | 470 CENTER ST
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City | CHARDON
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State | OH
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Zip | 44024-1098
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I1502398
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | OH1463002
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License Number State | OH
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