Provider Demographics
NPI:1740791649
Name:HEPWORTH, TYLDESLEY ANNE TAYLOR (LCSW)
Entity Type:Individual
Prefix:
First Name:TYLDESLEY
Middle Name:ANNE TAYLOR
Last Name:HEPWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TYLDESLEY
Other - Middle Name:ANNE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:30300 CAMINO CAPISTRANO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1304
Mailing Address - Country:US
Mailing Address - Phone:949-240-2030
Mailing Address - Fax:
Practice Address - Street 1:30300 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1304
Practice Address - Country:US
Practice Address - Phone:949-240-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX556881041C0700X
CA709911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical