MEDICARE: JILL EGBERT, LICSW, PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1194412825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JILL EGBERT, LICSW, PLLC

Provider Business Mailing Address
First Line	:	6265 ROUTE 7A
Second Line	:
City	:	ARLINGTON
State	:	VT
Zip	:	05250-8434
Country	:	US
Telephone Number	:	802-855-1427
Fax Number	:

Provider Business Practice Location Address
First Line	:	6265 ROUTE 7A
Second Line	:
City	:	ARLINGTON
State	:	VT
Zip	:	05250-8434
Country	:	US
Telephone Number	:	802-855-1427
Fax Number	:

Authorized Official
Title or Position	:	LICSW
Name	:	JILL EGBERT
Credential	:
Telephone Number	:	802-855-1427

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/21/2023

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