Provider Demographics
NPI:1871774836
Name:PANTALEO, JILL ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANN
Last Name:PANTALEO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W PASSAIC ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3105
Mailing Address - Country:US
Mailing Address - Phone:201-926-5550
Mailing Address - Fax:
Practice Address - Street 1:151 W PASSAIC ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3105
Practice Address - Country:US
Practice Address - Phone:201-926-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00265500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker