Provider Demographics
NPI:1497858328
Name:SEVILLA, DEANNA FAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:FAYE
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DEANNA
Other - Middle Name:FAYE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13112 HADLEY STREET
Mailing Address - Street 2:SUITE 106B
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4583
Mailing Address - Country:US
Mailing Address - Phone:562-693-8118
Mailing Address - Fax:323-340-1568
Practice Address - Street 1:13112 HADLEY STREET
Practice Address - Street 2:SUITE 106B
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4583
Practice Address - Country:US
Practice Address - Phone:562-693-8118
Practice Address - Fax:323-340-1568
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS88351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA143672OtherVALUE OPTIONS
CA050496OtherMANAGED HEALTH NETWORK
CA62-37257OtherUSBHPC
CA050539-000OtherMAGELLAN BEHAVIORAL HEALT
CA60054OtherAETNA
CA60054OtherAETNA