MEDICARE: ROBERT ANNON LCS

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	LCS 22850	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ92069Z	OTHER	CA	MEDICARE GROUP ID#
3	ZZZ92073Z	OTHER	CA	MEDICARE GROUP ID#
4	ZZZ91892Z	OTHER	CA	MEDICARE GROUP ID#
6	ZZZ91891Z	OTHER	CA	MEDICARE GROUP ID#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCS 22850	OTHER	CA	LICENSED SOCIAL WORKER
5	IMF 49673	OTHER	CA	INTERN MARRIAGE & FAMILY

General Provider Information

NPI Number	:	1992730121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ANNON LCS

Provider Business Mailing Address
First Line	:	1400 EMELINE AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1976
Country	:	US
Telephone Number	:	831-454-4170
Fax Number	:	831-454-4663

Provider Business Practice Location Address
First Line	:	1400 EMELINE AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1976
Country	:	US
Telephone Number	:	831-454-4170
Fax Number	:	831-454-4663

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/11/2008

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Directions to “ ROBERT ANNON LCS” Practice Location

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