Provider Demographics
NPI:1144469362
Name:RABINOVITZ, JILL SUZANNE (PSYD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:RABINOVITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:BARENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15843 50TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3471
Mailing Address - Country:US
Mailing Address - Phone:763-519-8000
Mailing Address - Fax:
Practice Address - Street 1:15843 50TH AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3471
Practice Address - Country:US
Practice Address - Phone:763-519-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional