Provider Demographics
NPI:1932337094
Name:COSGRAVE, JILL K (MS)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:K
Last Name:COSGRAVE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9343 TECH CENTER DR FL 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2563
Mailing Address - Country:US
Mailing Address - Phone:530-902-2598
Mailing Address - Fax:916-649-7158
Practice Address - Street 1:9343 TECH CENTER DR FL 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2563
Practice Address - Country:US
Practice Address - Phone:530-902-2598
Practice Address - Fax:916-649-7158
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist