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General NPI Number Information
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NPI Number | 1306164645
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Entity Type | Individual
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Provider Name | LYNN DORA WALDMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 3435 CAMINO DEL RIO SOUTH SUITE 217
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City | SAN DIEGO
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State | CA
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Zip | 92108-3902
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Country | US
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Telephone | 619-865-3203
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Fax | 619-294-9424
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Provider Business Mailing Address
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Address Line | 1325 PACIFIC HWY SUITE 605
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City | SAN DIEGO
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State | CA
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Zip | 92101-2580
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Country | US
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Telephone | 619-865-3203
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Fax | 619-294-9424
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS16999
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License Number State | CA
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