Provider Demographics
NPI:1760835318
Name:VERSCHAETSE, JILL MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:VERSCHAETSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:VERSCHAETSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:116 RECORD ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5418
Mailing Address - Country:US
Mailing Address - Phone:301-620-8700
Mailing Address - Fax:301-620-8710
Practice Address - Street 1:116 RECORD ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5418
Practice Address - Country:US
Practice Address - Phone:301-620-8700
Practice Address - Fax:301-620-8710
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical