Provider Demographics
NPI:1497927644
Name:DORN, JILL GEORGEANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:GEORGEANN
Last Name:DORN
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 1:2705 PALOS VERDES DR N
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1006
Mailing Address - Country:US
Mailing Address - Phone:310-863-0358
Mailing Address - Fax:
Practice Address - Street 1:2705 PALOS VERDES DR N
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1006
Practice Address - Country:US
Practice Address - Phone:310-863-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 239201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical