Provider Demographics
NPI:1881740025
Name:SILL, JUDITH PHILLIPS (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:PHILLIPS
Last Name:SILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:ELK
Mailing Address - State:CA
Mailing Address - Zip Code:95432-0065
Mailing Address - Country:US
Mailing Address - Phone:707-937-3000
Mailing Address - Fax:707-937-3373
Practice Address - Street 1:45121 UKIAH STREET
Practice Address - Street 2:SUITE G
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460
Practice Address - Country:US
Practice Address - Phone:707-937-3000
Practice Address - Fax:707-937-3373
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7543103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY075430Medicaid
CACP7543AMedicare PIN