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General NPI Number Information
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NPI Number | 1508238254
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Entity Type | Organization
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Legal Business Name | JILL DORN
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 24520 HAWTHORNE BLVD SUITE 220
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City | TORRANCE
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State | CA
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Zip | 90505-6800
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Country | US
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Telephone | 310-863-0358
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 PALOS VERDES DR N
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City | PLS VRDS EST
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State | CA
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Zip | 90274-1006
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Country | US
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Telephone | 310-863-0358
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERIAPIST
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Name | JILL DORN
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Credential | LCSW
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Telephone | 310-863-0358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS23920
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License Number State | CA
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