MEDICARE: MS. LYNN LIRETTE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS5446	CA

General Provider Information

NPI Number	:	1003820929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNN LIRETTE LCSW

Provider Business Mailing Address
First Line	:	5740 N PALM
Second Line	:	#105
City	:	FRESNO
State	:	CA
Zip	:	93704-1800
Country	:	US
Telephone Number	:	559-224-8419
Fax Number	:	559-431-1951

Provider Business Practice Location Address
First Line	:	5740 N PALM
Second Line	:	#105
City	:	FRESNO
State	:	CA
Zip	:	93704-1800
Country	:	US
Telephone Number	:	559-224-8419
Fax Number	:	559-431-1951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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