MEDICARE: PATRICIA WOJDOWSKI 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 8537	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CSW085370	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1396736195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA WOJDOWSKI LCSW

Provider Business Mailing Address
First Line	:	4926 LA CUENTA DR
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2609
Country	:	US
Telephone Number	:	858-292-0492
Fax Number	:	619-296-2130

Provider Business Practice Location Address
First Line	:	4926 LA CUENTA DR
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2609
Country	:	US
Telephone Number	:	858-292-0492
Fax Number	:	619-296-2130

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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