Provider Demographics
NPI:1619015856
Name:SULKA, JILL ERIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ERIN
Last Name:SULKA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 HARRISON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4536
Mailing Address - Country:US
Mailing Address - Phone:510-326-2002
Mailing Address - Fax:
Practice Address - Street 1:3911 HARRISON ST STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4536
Practice Address - Country:US
Practice Address - Phone:510-326-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19702103TC0700X
CAPSY19702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical