Provider Information for 1568071850
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JILLA LAVIAN LCSW
Sex: Female
NPI: 1568071850
Last Updated: 2020-07-23
Certification Date: 2020-07-23
Certification Date: 2020-07-23
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1568071850 | ||||||||
| Enumeration Date | 2020-07-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1240 LAKEVIEW DRIVE SAN MATEO, CA 94010 United States Phone: 650-799-5543 | Fax:650-375-8550 | ||||||||
| Primary Practice Address | 1240 LAKEVIEW DRIVE SAN MATEO, CA 94010 United States Phone: 650-799-5543 | Fax:650-375-8550 | ||||||||
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