Active NPI
Sandra Lee Lillie, PH.D.
- Clinical Psychologist
- Emerald Hills, CA
National Provider Identifier
1093083081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY8872
- Practice address
- 102 Vaquero Way
Emerald Hills, CA 94062-3152 - Phone
- (650) 368-5802
- Fax
- (650) 568-9800
- NPI assigned
- Dec 6, 2011
- Reactivated
- Sep 3, 2024
- Last updated
- Sep 3, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY8872 | CA | Primary |
Addresses
Primary practice location
102 Vaquero Way
Emerald Hills, CA 94062-3152
Mailing address
102 Vaquero Way
Emerald Hills, CA 94062-3152
Phone (650) 368-5802
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 14, 2024 through Jun 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY8872 | CA | MD | Clinical Psychologist |
| 8872 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725321600000",
"number": "1093083081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 VAQUERO WAY",
"city": "EMERALD HILLS",
"state": "CA",
"postal_code": "940623152",
"telephone_number": "650-368-5802",
"fax_number": "650-568-9800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 VAQUERO WAY",
"city": "EMERALD HILLS",
"state": "CA",
"postal_code": "940623152",
"telephone_number": "650-368-5802",
"fax_number": "650-568-9800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLIE",
"first_name": "SANDRA",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-06",
"last_updated": "2024-09-03",
"deactivation_date": "2024-08-21",
"reactivation_date": "2024-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY8872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Emerald Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.