Provider Demographics
NPI:1134517600
Name:LEMIEUX, MARY ELLEN LILES (JD, LCSW)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:LILES
Last Name:LEMIEUX
Suffix:
Gender:F
Credentials:JD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2011
Mailing Address - Country:US
Mailing Address - Phone:650-346-7698
Mailing Address - Fax:
Practice Address - Street 1:518 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2011
Practice Address - Country:US
Practice Address - Phone:650-346-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11557310-35011041C0700X
CO099263651041C0700X
CA735571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical