MEDICARE: JILL BAIRD LCSW

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	SW 1864	FL

General Provider Information

NPI Number	:	1285695254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL BAIRD LCSW

Provider Business Mailing Address
First Line	:	601 MCDONALD ST
Second Line	:	#510
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-4876
Country	:	US
Telephone Number	:	352-315-7534
Fax Number	:	352-360-6582

Provider Business Practice Location Address
First Line	:	515 W MAIN ST
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5148
Country	:	US
Telephone Number	:	352-315-7534
Fax Number	:	352-360-6582

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	07/09/2007

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Directions to “ JILL BAIRD LCSW” Practice Location

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