MEDICARE: MS. NANCY E. WILLIFORD LCSW, BCD

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	LCS 21571	CA

General Provider Information

NPI Number	:	1407865678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY E. WILLIFORD LCSW, BCD

Provider Business Mailing Address
First Line	:	2240 6TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2107
Country	:	US
Telephone Number	:	619-702-8833
Fax Number	:	619-232-9923

Provider Business Practice Location Address
First Line	:	4452 PARK BLVD
Second Line	:	SUITE 205
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4051
Country	:	US
Telephone Number	:	619-294-3500
Fax Number	:	619-232-9923

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

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	07/09/2007

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