MEDICARE: MS. JILL R EDELMAN M.S.W.

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	000210	CT

General Provider Information

NPI Number	:	1811995202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL R EDELMAN M.S.W.

Provider Business Mailing Address
First Line	:	9 SHADY LN
Second Line	:
City	:	REDDING
State	:	CT
Zip	:	06896-2322
Country	:	US
Telephone Number	:	203-938-9739
Fax Number	:	203-938-9739

Provider Business Practice Location Address
First Line	:	9 SHADY LN
Second Line	:
City	:	REDDING
State	:	CT
Zip	:	06896-2322
Country	:	US
Telephone Number	:	203-938-9739
Fax Number	:	203-938-9739

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/08/2007

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