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General NPI Number Information
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NPI Number | 1992858997
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Entity Type | Individual
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Provider Name | JILL A. GRACE HERSCH L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 3 COMMUNITY RD
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City | MARBLEHEAD
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State | MA
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Zip | 01945-2706
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Country | US
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Telephone | 541-488-0883
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Fax | 541-488-0893
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Provider Business Mailing Address
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Address Line | 3 COMMUNITY RD
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City | MARBLEHEAD
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State | MA
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Zip | 01945-2706
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Country | US
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Telephone | 541-488-0883
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Fax | 541-488-0893
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS19812
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L3235
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License Number State | OR
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