Provider Demographics
NPI:1114800927
Name:MANTILLA, JAMILLAH A (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMILLAH
Middle Name:A
Last Name:MANTILLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-0022
Mailing Address - Country:US
Mailing Address - Phone:732-684-3484
Mailing Address - Fax:
Practice Address - Street 1:120 PAYSAN LN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:DE
Practice Address - Zip Code:19962-3692
Practice Address - Country:US
Practice Address - Phone:877-282-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health