Provider Demographics
NPI:1467177220
Name:SITHIPHONG, JUDY ANN DE LEON (MSW)
Entity Type:Individual
Prefix:
First Name:JUDY ANN
Middle Name:DE LEON
Last Name:SITHIPHONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23504 LYONS AVE STE 402B
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5777
Mailing Address - Country:US
Mailing Address - Phone:818-217-0669
Mailing Address - Fax:
Practice Address - Street 1:23504 LYONS AVE STE 402B
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-5777
Practice Address - Country:US
Practice Address - Phone:818-217-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical