MEDICARE: MR. LEONARD F SZYMCZAK MSW 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	149003726	IL
2	1041C0700X	Clinical Social Worker	LCS 23713	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632058	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1124192117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEONARD F SZYMCZAK MSW LCSW

Provider Business Mailing Address
First Line	:	23705 MARINER DR
Second Line	:	# 183
City	:	MONARCH BEACH
State	:	CA
Zip	:	92629-4306
Country	:	US
Telephone Number	:	949-443-4888
Fax Number	:

Provider Business Practice Location Address
First Line	:	23705 MARINER DR
Second Line	:	# 183
City	:	MONARCH BEACH
State	:	CA
Zip	:	92629-4306
Country	:	US
Telephone Number	:	949-443-4888
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	01/29/2015

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Directions to “ MR. LEONARD F SZYMCZAK MSW LCSW” Practice Location

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