MEDICARE: MS. CHRISTINE ARLENE PEMBERTON 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	LCS16760	CA

General Provider Information

NPI Number	:	1083716120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE ARLENE PEMBERTON LCSW

Provider Business Mailing Address
First Line	:	3035 MYRTLE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4250
Country	:	US
Telephone Number	:	619-302-5899
Fax Number	:	619-528-8054

Provider Business Practice Location Address
First Line	:	3420 KENYON STREET
Second Line	:	KAISER PERMANENTE
City	:	SAN DIEGO
State	:	CA
Zip	:	92110
Country	:	US
Telephone Number	:	619-302-5899
Fax Number	:	618-528-8054

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	01/14/2022

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