MEDICARE: JEAN SHIMOZAKI 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	LCS 11739	CA

General Provider Information

NPI Number	:	1093867343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN SHIMOZAKI LCSW

Provider Business Mailing Address
First Line	:	3099 TELEGRAPH AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2035
Country	:	US
Telephone Number	:	510-845-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	3099 TELEGRAPH AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2035
Country	:	US
Telephone Number	:	510-845-8830
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	01/31/2011

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