Provider Demographics
NPI:1508271461
Name:JILLIAN STERNER
Entity Type:Organization
Organization Name:JILLIAN STERNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-223-7070
Mailing Address - Street 1:1798 MAEVE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7350
Mailing Address - Country:US
Mailing Address - Phone:321-223-7070
Mailing Address - Fax:
Practice Address - Street 1:1798 MAEVE CIR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7350
Practice Address - Country:US
Practice Address - Phone:321-223-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 2116251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health