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General NPI Number Information
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NPI Number | 1417577792
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Entity Type | Organization
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Legal Business Name | BRIAN SEAN STILLER LICENSED CLINICAL SOCIAL WORKER INC
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 11622 EL CAMINO REAL STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92130-2051
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Country | US
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Telephone | 858-215-4044
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Fax |
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Provider Business Mailing Address
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Address Line | 1367 E GOSHEN AVE
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City | FRESNO
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State | CA
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Zip | 93720-2648
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Country | US
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Telephone | 903-246-1953
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN SEAN STILLER
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Credential | LCSW
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Telephone | 858-215-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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