MEDICARE: MRS. SHAUDI ADEL 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	109653	TX
2	1041C0700X	Clinical Social Worker	86318	CA
3	1041C0700X	Clinical Social Worker
4	1041C0700X	Clinical Social Worker	18280	FL
5	1041C0700X	Clinical Social Worker	087823	NY

General Provider Information

NPI Number	:	1164730974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAUDI ADEL LCSW

Provider Business Mailing Address
First Line	:	1968 S COAST HWY # 5025
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:	858-215-3885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 S COAST HWY # 5025
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:	858-215-3885
Fax Number	:

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	11/09/2023

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