Provider Demographics
NPI:1346417938
Name:ROSICKI, JILL STAR
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:STAR
Last Name:ROSICKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 W VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2175
Mailing Address - Country:US
Mailing Address - Phone:310-603-1030
Mailing Address - Fax:
Practice Address - Street 1:161 W VICTORIA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2175
Practice Address - Country:US
Practice Address - Phone:310-603-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health