| Doctor Name: | DENISE I. TILLERY |
| NPI Number: | 1205085263 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LCSW65928 |
| Business Practice Address: | 500 Jefferson Blvd Suite 195 West Sacramento, CA - 956052350 |
| Business Phone Number: | 9164032970 |
| Business Fax Number: | 5302045255 |
| Mailing Address: | 500 Jefferson Blvd, Suite 195 WEST SACRAMENTO |
| State: | CA |
| Postal Code: | 956052350 |
| Phone Number: | 9164032970 |
| Fax Number: | 5302045255 |
| NPI Enumeration Date: | 09/15/2008 |
| NPI Last Update Date: | 06/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW65928 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |