Provider Demographics
NPI:1700807542
Name:KO, LILA KWAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LILA
Middle Name:KWAN
Last Name:KO
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 1:1268 SANTA FE
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3705
Mailing Address - Country:US
Mailing Address - Phone:510-741-1233
Mailing Address - Fax:
Practice Address - Street 1:1801 BUSH ST STE 115
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5295
Practice Address - Country:US
Practice Address - Phone:510-741-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS87091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical