MEDICARE: MS. JAN MARIE CLICK MSW

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 14689	CA

General Provider Information

NPI Number	:	1457462350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAN MARIE CLICK MSW

Provider Business Mailing Address
First Line	:	25852 MCBEAN PKWY
Second Line	:	SUITE 412
City	:	VALENCIA
State	:	CA
Zip	:	91355-2004
Country	:	US
Telephone Number	:	661-632-2551
Fax Number	:	661-554-3253

Provider Business Practice Location Address
First Line	:	28494 WESTINGHOUSE PL
Second Line	:	SUITE 203
City	:	VALENCIA
State	:	CA
Zip	:	91355-0930
Country	:	US
Telephone Number	:	661-632-2551
Fax Number	:	661-554-3253

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/06/2013

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