Provider Demographics
NPI:1508238254
Name:JILL DORN
Entity Type:Organization
Organization Name:JILL DORN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERIAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-863-0358
Mailing Address - Street 1:2705 PALOS VERDES DR N
Mailing Address - Street 2:
Mailing Address - City:PLS VRDS EST
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 1:24520 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6800
Practice Address - Country:US
Practice Address - Phone:310-863-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS239201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty