MEDICARE: LILY DIEP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW87879	CA

General Provider Information

NPI Number	:	1962281584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY DIEP

Provider Business Mailing Address
First Line	:	1120 E 28TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-4021
Country	:	US
Telephone Number	:	510-520-7858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 PARK ST # 1014
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4507
Country	:	US
Telephone Number	:	510-469-0292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	10/17/2025

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Directions to “ LILY DIEP ” Practice Location

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