MEDICARE: DR. NANCY LOUISE RONNE 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	102L00000X	Psychoanalyst	LCS 15292	CA
2	1041C0700X	Clinical Social Worker	LCSW 15292	CA

General Provider Information

NPI Number	:	1083999429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY LOUISE RONNE LCSW

Provider Business Mailing Address
First Line	:	11633 SAN VICENTE BLVD STE 240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6513
Country	:	US
Telephone Number	:	310-242-0031
Fax Number	:

Provider Business Practice Location Address
First Line	:	11633 SAN VICENTE BLVD STE 240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6513
Country	:	US
Telephone Number	:	310-242-0031
Fax Number	:

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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