Provider Demographics
NPI:1609815455
Name:KHALILI, LILA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LILA
Middle Name:
Last Name:KHALILI
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 1:142 N AVENIDA BARCA
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2305
Mailing Address - Country:US
Mailing Address - Phone:714-624-0651
Mailing Address - Fax:714-998-2941
Practice Address - Street 1:33 CREEK RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7707
Practice Address - Country:US
Practice Address - Phone:714-624-0651
Practice Address - Fax:714-998-2941
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS216481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW21648-AMedicare ID - Type Unspecified