Provider Demographics
NPI:1740419399
Name:DILLOF, FAY ANN
Entity type:Individual
Prefix:MS
First Name:FAY
Middle Name:ANN
Last Name:DILLOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1713
Mailing Address - Country:US
Mailing Address - Phone:510-333-6693
Mailing Address - Fax:
Practice Address - Street 1:1530 5TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1713
Practice Address - Country:US
Practice Address - Phone:510-333-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical