Provider Demographics
NPI:1285861302
Name:VAN CLEAVE, LILY (PSYD)
Entity type:Individual
Prefix:DR
First Name:LILY
Middle Name:
Last Name:VAN CLEAVE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N CENTRAL AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4262
Mailing Address - Country:US
Mailing Address - Phone:310-729-7887
Mailing Address - Fax:
Practice Address - Street 1:715 N CENTRAL AVE
Practice Address - Street 2:STE 108
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4262
Practice Address - Country:US
Practice Address - Phone:310-729-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23821103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical