MEDICARE: MS. JEAN MARIE BENWARD 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	8933	CA

General Provider Information

NPI Number	:	1821053414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN MARIE BENWARD LCSW

Provider Business Mailing Address
First Line	:	18 CROW CANYON CT
Second Line	:	STE 305
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1922
Country	:	US
Telephone Number	:	925-820-9023
Fax Number	:	510-538-5410

Provider Business Practice Location Address
First Line	:	18 CROW CANYON CT
Second Line	:	STE 305
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1922
Country	:	US
Telephone Number	:	925-820-9023
Fax Number	:	510-538-5410

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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