Provider Demographics
NPI:1184169674
Name:MINSKY, JILL L (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:L
Last Name:MINSKY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:L
Other - Last Name:MINSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:318 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2309
Mailing Address - Country:US
Mailing Address - Phone:410-963-4789
Mailing Address - Fax:
Practice Address - Street 1:1501 SULGRAVE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3654
Practice Address - Country:US
Practice Address - Phone:410-963-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical