Provider Demographics
NPI:1396076097
Name:MOGARTOFF, LILY E (LCSW)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:E
Last Name:MOGARTOFF
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 1:151 KALMUS DR
Mailing Address - Street 2:SUITE K-1
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5988
Mailing Address - Country:US
Mailing Address - Phone:800-577-4701
Mailing Address - Fax:714-242-9268
Practice Address - Street 1:151 KALMUS DR
Practice Address - Street 2:SUITE K-1
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5988
Practice Address - Country:US
Practice Address - Phone:800-577-4701
Practice Address - Fax:714-242-9268
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical