MEDICARE: LUCY O'DWYER

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	106H00000X	Marriage & Family Therapist	130395	CA

General Provider Information

NPI Number	:	1033980362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY O'DWYER

Provider Business Mailing Address
First Line	:	718 JUDAH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-2114
Country	:	US
Telephone Number	:	415-992-2095
Fax Number	:

Provider Business Practice Location Address
First Line	:	822 D ST
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-2814
Country	:	US
Telephone Number	:	510-527-1918
Fax Number	:

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

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/15/2024

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Directions to “ LUCY O'DWYER ” Practice Location

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