MEDICARE: KELLY MCCANN EARLS LCSW, MPH

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	71904	CA

General Provider Information

NPI Number	:	1205417995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MCCANN EARLS LCSW, MPH

Provider Business Mailing Address
First Line	:	58 PAULDING ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2440
Country	:	US
Telephone Number	:	860-463-4327
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 PAULDING ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2440
Country	:	US
Telephone Number	:	860-463-4327
Fax Number	:

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

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/15/2021

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