Provider Demographics
NPI:1063564953
Name:CUMMINGS-LILLY, KAREN THERESA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:THERESA
Last Name:CUMMINGS-LILLY
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 1:784 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5426
Mailing Address - Country:US
Mailing Address - Phone:304-640-5666
Mailing Address - Fax:
Practice Address - Street 1:784 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5426
Practice Address - Country:US
Practice Address - Phone:304-640-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009408641041C0700X
CALCS 132741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical