Provider Demographics
NPI:1568071850
Name:LAVIAN, JILLA (LCSW)
Entity Type:Individual
Prefix:
First Name:JILLA
Middle Name:
Last Name:LAVIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94010
Mailing Address - Country:US
Mailing Address - Phone:650-799-5543
Mailing Address - Fax:650-375-8550
Practice Address - Street 1:1240 LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94010
Practice Address - Country:US
Practice Address - Phone:650-799-5543
Practice Address - Fax:650-375-8550
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical