Basic Information
| Provider Information | |||||||||
| NPI: | 1861675183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GURETSE | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 ELINOR WAY | ||||||||
| Address2: | |||||||||
| City: | EAST GREENVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180412146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4847882285 | ||||||||
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| Practice Location | |||||||||
| Address1: | 807 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152576551 | ||||||||
| FaxNumber: | 2152574008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2007 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | CW018154 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.