Provider Demographics
NPI:1275863144
Name:ISLAND, MILTON LEE (ACSW)
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:LEE
Last Name:ISLAND
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9258 LEMONA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3414
Mailing Address - Country:US
Mailing Address - Phone:188-893-8852
Mailing Address - Fax:
Practice Address - Street 1:5300 W AVENUE I
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-8312
Practice Address - Country:US
Practice Address - Phone:166-194-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW275381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW27538OtherACSW CERTIFICATE