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NPI Code Detail

MEDICARE: SUSAN GERDTZ LCSW

MEDICARE: SUSAN GERDTZ LCSW
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
11041C0700XClinical Social WorkerLCSW28488CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053463166
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN GERDTZ LCSW
Provider Business Mailing Address
First Line : 2110 WILMINGTON DR
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-6239
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 801 EMPIRE ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-5702
Country : US
Telephone Number : 707-425-5744
Fax Number : 707-425-5162
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 02/28/2017

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Directions to “ SUSAN GERDTZ LCSW” Practice Location

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