MEDICARE: MR. BRYCETON N. DANICO 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	LCS20979	CA

General Provider Information

NPI Number	:	1124114020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYCETON N. DANICO LCSW

Provider Business Mailing Address
First Line	:	6060 N PARAMOUNT BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-3711
Country	:	US
Telephone Number	:	562-634-9534
Fax Number	:	562-790-1861

Provider Business Practice Location Address
First Line	:	6060 N PARAMOUNT BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-3711
Country	:	US
Telephone Number	:	562-634-9534
Fax Number	:	562-790-1861

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	12/03/2009

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