MEDICARE: MS. SULABHA SUNIL ABHYANKAR 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	19426	CA

General Provider Information

NPI Number	:	1750537841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SULABHA SUNIL ABHYANKAR LCSW

Provider Business Mailing Address
First Line	:	PO BOX 80892
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-0892
Country	:	US
Telephone Number	:	949-584-1031
Fax Number	:

Provider Business Practice Location Address
First Line	:	24351 MOULTON PKWY STE 120
Second Line	:
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-3352
Country	:	US
Telephone Number	:	949-584-1031
Fax Number	:

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/08/2008

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