Provider Demographics
NPI:1053952564
Name:GILLIARD, JENNIFER DENISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DENISE
Last Name:GILLIARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GILLIARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, RPT
Mailing Address - Street 1:419 WHALLEY AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3019
Mailing Address - Country:US
Mailing Address - Phone:203-439-5555
Mailing Address - Fax:
Practice Address - Street 1:419 WHALLEY AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3019
Practice Address - Country:US
Practice Address - Phone:203-439-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT98551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical