MEDICARE: SHIRANI M PATHAK 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	LCS 28153	CA

General Provider Information

NPI Number	:	1457509689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRANI M PATHAK LCSW

Provider Business Mailing Address
First Line	:	PO BOX 24813
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95154-4813
Country	:	US
Telephone Number	:	408-502-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 ROSS AVE STE 308
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3039
Country	:	US
Telephone Number	:	408-502-6790
Fax Number	:

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

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	05/07/2015

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Directions to “ SHIRANI M PATHAK LCSW” Practice Location

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