MEDICARE: JILL KLEPETAR 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	LCS17594	CA

General Provider Information

NPI Number	:	1215250006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL KLEPETAR LCSW

Provider Business Mailing Address
First Line	:	4735 WHITE OAK PL
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-3726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4735 WHITE OAK PL
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-3726
Country	:	US
Telephone Number	:	818-996-7728
Fax Number	:	818-705-6817

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

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	03/08/2010

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