MEDICARE: MR. MARK LUDWIG 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	19530	CA

General Provider Information

NPI Number	:	1245511484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK LUDWIG LCSW

Provider Business Mailing Address
First Line	:	201 HIGHLAND AVE.
Second Line	:
City	:	PIEDMONT
State	:	CA
Zip	:	94611
Country	:	US
Telephone Number	:	510-387-5845
Fax Number	:

Provider Business Practice Location Address
First Line	:	2246 6TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2219
Country	:	US
Telephone Number	:	510-387-5845
Fax Number	:

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

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/01/2011

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