MEDICARE: MS. MARA LEE WARMBRAND 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	LCS12534	CA

General Provider Information

NPI Number	:	1861532681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARA LEE WARMBRAND LCSW

Provider Business Mailing Address
First Line	:	2886 SANFORD LANE
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92010
Country	:	US
Telephone Number	:	760-439-1128
Fax Number	:	760-439-1128

Provider Business Practice Location Address
First Line	:	2003 EL CAMINO REAL
Second Line	:	#107
City	:	OCEANSIDE
State	:	CA
Zip	:	92054
Country	:	US
Telephone Number	:	760-439-1128
Fax Number	:	760-439-1128

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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