MEDICARE: MRS. BARBARA DE SOTO 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	LCS14271	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCS14271	OTHER	CA	LCSW LICENSE

General Provider Information

NPI Number	:	1841419744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA DE SOTO LCSW

Provider Business Mailing Address
First Line	:	5151 N PALM AVE STE 890
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2208
Country	:	US
Telephone Number	:	559-226-4322
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 N PALM AVE STE 890
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2208
Country	:	US
Telephone Number	:	559-226-4322
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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