Provider Demographics
NPI:1639810054
Name:LILLENBERG, AUSTIN KEVIN (ASW)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:KEVIN
Last Name:LILLENBERG
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:2801 SANTA MARIA WAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-2118
Practice Address - Country:US
Practice Address - Phone:805-934-5400
Practice Address - Fax:805-938-9207
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1154241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical