Provider Demographics
NPI:1134372733
Name:MILLIGAN, MARILYN J (LCSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:MILLIGAN
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 1:1530 N. ACACIA AVE.
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1205
Mailing Address - Country:US
Mailing Address - Phone:714-871-2657
Mailing Address - Fax:
Practice Address - Street 1:12675 LA MIRRADA BLVD.
Practice Address - Street 2:SUITE 419
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2200
Practice Address - Country:US
Practice Address - Phone:562-906-8832
Practice Address - Fax:562-906-8852
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS19741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical