| Doctor Name: | DR. SANDRA LEE LILLIE |
| NPI Number: | 1093083081 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | PSY8872 |
| Business Practice Address: | 102 Vaquero Way Emerald Hills, CA - 940623152 |
| Business Phone Number: | 6503685802 |
| Business Fax Number: | 6505689800 |
| Mailing Address: | 102 Vaquero Way, EMERALD HILLS |
| State: | CA |
| Postal Code: | 940623152 |
| Phone Number: | 6503685802 |
| Fax Number: | 6505689800 |
| NPI Enumeration Date: | 12/06/2011 |
| NPI Last Update Date: | 12/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY8872 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |