Provider Demographics
NPI:1255489837
Name:DIBIANCA, LILLIAN (MA)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:DIBIANCA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:DIBIANCA
Other - Last Name:STILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:760 KENMORE CIR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5413
Mailing Address - Country:US
Mailing Address - Phone:805-427-1476
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2612
Practice Address - Country:US
Practice Address - Phone:805-427-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health