MEDICARE: MRS. LORI LEE BUELNA 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	19700	CA

General Provider Information

NPI Number	:	1770594962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI LEE BUELNA LCSW

Provider Business Mailing Address
First Line	:	5855 SILVER CREEK VALLEY PLACE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138
Country	:	US
Telephone Number	:	650-493-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 SILVER CREEK VALLEY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1059
Country	:	US
Telephone Number	:	650-493-5000
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	09/26/2019

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