MEDICARE: MRS. JILL SHERIE DI CARLO LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC42656	CA

General Provider Information

NPI Number	:	1871611020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL SHERIE DI CARLO LMFT

Provider Business Mailing Address
First Line	:	3450 PALMER DRIVE
Second Line	:	SUITE 4148
City	:	CAMERON PARK
State	:	CA
Zip	:	95682
Country	:	US
Telephone Number	:	530-210-6782
Fax Number	:	916-923-0170

Provider Business Practice Location Address
First Line	:	3870 ROSIN COURT
Second Line	:	SUITE 130
City	:	SACRAMENTO
State	:	CA
Zip	:	95834
Country	:	US
Telephone Number	:	530-210-6782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/30/2023

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