=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255619623
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN MAUREEN TWOMEY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2011
-----------------------------------------------------
Last Update Date | 01/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 GREAT OAKS BLVD, B208 (180D/SJC)
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95119-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-295-1439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3101 PAUL SWEET RD
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95065-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-295-1439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 26604
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------