MEDICARE: DEANNA BROWNSON LCS 20780

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 20780	CA

General Provider Information

NPI Number	:	1053349563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA BROWNSON LCS 20780

Provider Business Mailing Address
First Line	:	PO BOX 1396
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92531-1396
Country	:	US
Telephone Number	:	951-471-2503
Fax Number	:	951-471-2503

Provider Business Practice Location Address
First Line	:	309 W HEALD AVE
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-3733
Country	:	US
Telephone Number	:	951-471-2503
Fax Number	:	951-471-2503

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	06/11/2009

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