Healthcare Provider Details

I. General information

NPI: 1700379104
Provider Name (Legal Business Name): LILLIANA ELIZABETH DUNBAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MALTMAN DR
GRASS VALLEY CA
95945-5184
US

IV. Provider business mailing address

715 MALTMAN DR
GRASS VALLEY CA
95945-5184
US

V. Phone/Fax

Practice location:
  • Phone: 530-575-5670
  • Fax:
Mailing address:
  • Phone: 530-575-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: