Provider Demographics
NPI:1053182378
Name:PALERMO, JILLIAN HARRINGTON
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:HARRINGTON
Last Name:PALERMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ELIZABETH
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 PARKMOOR AVE APT 1425
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3567
Mailing Address - Country:US
Mailing Address - Phone:781-568-9947
Mailing Address - Fax:
Practice Address - Street 1:1302 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4713
Practice Address - Country:US
Practice Address - Phone:669-308-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-261171106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician