Provider Demographics
NPI:1477036879
Name:SORKIN, JILLIAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:SORKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 HORN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2101
Mailing Address - Country:US
Mailing Address - Phone:310-951-2499
Mailing Address - Fax:
Practice Address - Street 1:152 S LASKY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1720
Practice Address - Country:US
Practice Address - Phone:310-951-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist