Provider Demographics
NPI:1528892262
Name:PROLMAN, JILL (PHD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:PROLMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13954 BOQUITA DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3108
Mailing Address - Country:US
Mailing Address - Phone:858-775-5571
Mailing Address - Fax:
Practice Address - Street 1:171 SAXONY RD STE 214
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6782
Practice Address - Country:US
Practice Address - Phone:760-599-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical