MEDICARE: MR. JEFF RACKMIL 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
1	1041C0700X	Clinical Social Worker	LCS11132	CA

General Provider Information

NPI Number	:	1063536191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFF RACKMIL LCSW

Provider Business Mailing Address
First Line	:	2648 CELAYA CIR
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2042
Country	:	US
Telephone Number	:	925-830-1337
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 EMBARCADERO
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-5334
Country	:	US
Telephone Number	:	510-383-1748
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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