Provider Demographics
NPI:1073050282
Name:LE, LILY
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:LE
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 1:1340 TULLY RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3055
Mailing Address - Country:US
Mailing Address - Phone:408-271-3900
Mailing Address - Fax:408-271-3909
Practice Address - Street 1:1340 TULLY RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:408-271-3900
Practice Address - Fax:408-271-3909
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker