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NPI Code Detail

MEDICARE: GEORGE PETER DAVIDSON LCSW

MEDICARE: GEORGE PETER DAVIDSON 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
11041C0700XClinical Social Worker21627CA

General Provider Information

NPI Number : 1891862827
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE PETER DAVIDSON LCSW
Provider Business Mailing Address
First Line : 1045 W REDONDO BEACH BLVD STE 300
Second Line :
City : GARDENA
State : CA
Zip : 90247-4175
Country : US
Telephone Number : 323-241-6730
Fax Number :
Provider Business Practice Location Address
First Line : 1045 W REDONDO BEACH BLVD STE 300
Second Line :
City : GARDENA
State : CA
Zip : 90247-4175
Country : US
Telephone Number : 323-241-6730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/10/2023

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Directions to “ GEORGE PETER DAVIDSON LCSW” Practice Location

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