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NPI Code Detail

MEDICARE: MS. JEAN LAURA WHELAN L.C.S.W.

MEDICARE: MS. JEAN LAURA WHELAN L.C.S.W.
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
11041C0700XClinical Social WorkerLCS 10290CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LCS 10290OTHERCALCSW LICENSE

General Provider Information

NPI Number : 1437213568
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEAN LAURA WHELAN L.C.S.W.
Provider Business Mailing Address
First Line : 975 SERENO DR
Second Line :
City : VALLEJO
State : CA
Zip : 94589-2441
Country : US
Telephone Number : 707-651-4039
Fax Number :
Provider Business Practice Location Address
First Line : 975 SERENO DR
Second Line : BAY VIEW SOUTH
City : VALLEJO
State : CA
Zip : 94589-2441
Country : US
Telephone Number : 707-651-4039
Fax Number : 707-651-4445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 07/08/2007

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