MEDICARE: KATHRYN FISHMAN GOWAN 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	84942	CA
2	1041C0700X	Clinical Social Worker	68621	CA

General Provider Information

NPI Number	:	1508223413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN FISHMAN GOWAN LCSW

Provider Business Mailing Address
First Line	:	2358 UNIVERSITY AVE # 2099
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2720
Country	:	US
Telephone Number	:	781-956-1177
Fax Number	:

Provider Business Practice Location Address
First Line	:	2358 UNIVERSITY AVE # 2099
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2720
Country	:	US
Telephone Number	:	781-956-1177
Fax Number	:

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

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	05/16/2025

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