MEDICARE: BETTY PLEWAK 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	LCSW 14962	CA

General Provider Information

NPI Number	:	1205985207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY PLEWAK LCSW

Provider Business Mailing Address
First Line	:	2351 CARDINAL LN
Second Line	:	ANNEX B
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3743
Country	:	US
Telephone Number	:	858-573-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 CARDINAL LN
Second Line	:	ANNEX B
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3743
Country	:	US
Telephone Number	:	858-573-2227
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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