Provider Demographics
NPI:1861615502
Name:SILLS, JUDITH H (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:H
Last Name:SILLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16052 BEACH BLVD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3801
Mailing Address - Country:US
Mailing Address - Phone:714-841-3465
Mailing Address - Fax:949-723-1937
Practice Address - Street 1:23 FREMONT STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4427
Practice Address - Country:US
Practice Address - Phone:714-329-2248
Practice Address - Fax:949-723-1937
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS79741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical