| Willow Tree Licensed Clinical Social Worker | |
|
2103 S El Camino Real Ste 206 Oceanside CA 92054-6281 | |
| (442) 500-8548 | |
| (760) 400-8379 |
| Full Name | Willow Tree Licensed Clinical Social Worker |
|---|---|
| Speciality | Social Worker |
| Location | 2103 S El Camino Real Ste 206, Oceanside, California |
| Authorized Official Name and Position | Sibelia Lisanne Chaiyahat (CEO) |
| Authorized Official Contact | 4425008548 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Tree Licensed Clinical Social Worker 2103 S El Camino Real Ste 202 Oceanside CA 92054-6281 Ph: (442) 500-8548 | Willow Tree Licensed Clinical Social Worker 2103 S El Camino Real Ste 206 Oceanside CA 92054-6281 Ph: (442) 500-8548 |
| NPI Number | 1245069616 |
|---|---|
| Provider Enumeration Date | 08/01/2024 |
| Last Update Date | 03/03/2025 |
| Certification Date | 03/03/2025 |
| Medicare PECOS PAC ID | 1153842497 |
|---|---|
| Medicare Enrollment ID | O20250304000878 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245069616 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sibelia L Chaiyahat |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447346523 PECOS PAC ID: 8527098334 Enrollment ID: I20150424001844 |
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