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NPI Code Detail

MEDICARE: MARYAM AZIZ LCSW

MEDICARE: MARYAM AZIZ 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
11041C0700XClinical Social WorkerLCS29589CA

General Provider Information

NPI Number : 1720415201
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYAM AZIZ LCSW
Provider Business Mailing Address
First Line : 200 FREEDOM LN
Second Line :
City : ALISO VIEJO
State : CA
Zip : 92656-5876
Country : US
Telephone Number : 949-338-4249
Fax Number :
Provider Business Practice Location Address
First Line : 200 FREEDOM LN
Second Line :
City : ALISO VIEJO
State : CA
Zip : 92656-5876
Country : US
Telephone Number : 949-900-8419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2013
Last Update Date : 11/18/2021

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